Individual
LISA DIANE CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
265 N BROADWAY ST, PORTLAND, OR 97227-1800
(503) 274-4885
(503) 274-4814
Mailing address
265 N BROADWAY ST, PORTLAND, OR 97227-1800
(503) 274-4885
(503) 274-4814
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200550098
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1022791
—
WA
05
—
273968
—
OR
Enumeration date
02/27/2006
Last updated
12/22/2011
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