Individual
MS. LISA WALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 652-2880
Mailing address
51654 SE 6TH ST, SCAPPOOSE, OR 97056-4504
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
201240001
OR
363LF0000X
Family Nurse Practitioner
Primary
201907739NP-PP
OR
Other
Enumeration date
08/15/2018
Last updated
11/27/2023
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