Individual
JUSTINE LISELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MPA-C
Contact information
Practice address
525 N COLUMBIA RIVER HWY, SAINT HELENS, OR 97051-1226
(503) 366-6244
Mailing address
2010 NW FRONT AVE, APT. C501, PORTLAND, OR 97209-1852
(570) 423-2141
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA172389
OR
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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