Provider Demographics
NPI:1487274361
Name:ROHM, LISA LEE (NP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LEE
Last Name:ROHM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40551 LITTLE RIVER AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:CA
Mailing Address - Zip Code:95456-9665
Mailing Address - Country:US
Mailing Address - Phone:503-708-8182
Mailing Address - Fax:
Practice Address - Street 1:525 MADRONA AVE
Practice Address - Street 2:
Practice Address - City:PORT ORFORD
Practice Address - State:OR
Practice Address - Zip Code:97465-9552
Practice Address - Country:US
Practice Address - Phone:541-332-3281
Practice Address - Fax:541-332-0250
Is Sole Proprietor?:No
Enumeration Date:2020-04-21
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10008819APRN-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily