Individual
LISA M WHEATLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
920 COUNTRY CLUB RD, STE 200A, EUGENE, OR 97401-6024
(541) 342-2134
(541) 686-6021
Mailing address
PO BOX 1648, EUGENE, OR 97440-1648
(541) 342-2134
(541) 686-6021
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
Primary
MD21920
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134129
—
OR
Enumeration date
12/30/2005
Last updated
04/01/2009
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