Basic Information
| Provider Information | |||||||||
| NPI: | 1356094148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | CNP, PMHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11850 SW 67TH AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036476456 | ||||||||
| FaxNumber: | 2082388888 | ||||||||
| Practice Location | |||||||||
| Address1: | 11850 SW 67TH AVE STE 105 | ||||||||
| Address2: | |||||||||
| City: | TIGARD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972238963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5036476456 | ||||||||
| FaxNumber: | 2082388888 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2022 | ||||||||
| LastUpdateDate: | 08/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 70995 | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.