Individual
LISA PUMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PMHNP
Contact information
Practice address
610 SW ALDER ST, SUITE 915, PORTLAND, OR 97205-3625
(503) 830-1624
(503) 452-2872
Mailing address
8635 SW 52ND AVE, PORTLAND, OR 97219-3318
(503) 452-9803
(503) 452-2872
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
087006211N6
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
090511
—
OR
05
—
223347
—
OR
Enumeration date
06/07/2006
Last updated
03/21/2013
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