Individual
MR. DEREK C LISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
950 MEDICAL DR, BRIGHAM CITY, UT 84302-4724
(435) 734-9471
Mailing address
PO BOX 4268, PORTLAND, OR 97208-4268
(503) 372-2740
(503) 373-2754
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
TEMP RNA 19861
ID
Other
Enumeration date
02/09/2009
Last updated
10/26/2021
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