Provider Demographics
NPI:1871531806
Name:ROESSEL, LISA L (FNP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:L
Last Name:ROESSEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:L
Other - Last Name:GUTWENIGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2222 NW LOVEJOY ST
Mailing Address - Street 2:SUITE 411, MOB 1
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-413-5702
Mailing Address - Fax:503-413-6499
Practice Address - Street 1:2222 NW LOVEJOY ST
Practice Address - Street 2:SUITE 411, MOB 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210
Practice Address - Country:US
Practice Address - Phone:503-413-5702
Practice Address - Fax:503-413-6499
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650023NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily