Individual
LISA D TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
200 GWEE-SHUT ROAD, SILETZ, OR 97380
(541) 444-1030
(541) 444-9695
Mailing address
PO BOX 320, SILETZ, OR 97380-0320
(541) 444-1030
(541) 444-9695
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
087006473RN
OR
363LF0000X
Family Nurse Practitioner
Primary
087006473N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
273019
—
OR
Enumeration date
09/01/2006
Last updated
02/22/2017
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