Provider Demographics
NPI:1366876724
Name:PETERS, LISA RENE (NP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENE
Last Name:PETERS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RENE
Other - Last Name:GIEBLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1793 13TH ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-2541
Mailing Address - Country:US
Mailing Address - Phone:503-362-8385
Mailing Address - Fax:503-362-8435
Practice Address - Street 1:1793 13TH ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-2541
Practice Address - Country:US
Practice Address - Phone:503-362-8385
Practice Address - Fax:503-362-8435
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1312A363LF0000X
OR201401222NP-PP363LF0000X
WAAP60452758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily