MS. LISA MARIE NYSTROM (NPI# 1790254399) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790254399 |
| Entity Type | Individual |
| Full Name | MS. LISA MARIE NYSTROM |
| Credential | LPN |
| Practice Address |
722 Ne 162nd Ave Portland OR 97230-5760 |
| Mailing Address |
424 Ne 22nd Ave Portland OR 97232-2809 |
| Practice Telephone | 5032398101 |
| Practice Fax Number | 5034085201 |
| Enumeration Date | 2018-11-13 |
| Last Update Date | 2018-11-13 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 164W00000X | Licensed Practical Nurse | 201806297LPN | OR | Nursing Service Providers |
| Street Address |
722 NE 162ND AVE |
| City | PORTLAND |
| State | OR |
| Zip Code | 97230-5760 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235237983 | Catherine N. Knox | Counselor | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2006-09-20 |
| 1548860463 | Michele Renee Coon | Counselor | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2020-10-29 |
| 1710594551 | Anna Christine Peaslee | Social Worker | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2020-09-25 |
| 1164040739 | Samantha Bedker | Social Worker | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2020-07-10 |
| 1417572033 | Veronica Shiu Knight | Social Worker | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2020-06-09 |
| 1215550850 | Nathalie Wuebkes | Technician | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2020-05-18 |
| 1104446509 | Erin Marie Mcdermott | Behavior Technician | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2020-04-26 |
| 1174150536 | Jessica Schnur | Marriage & Family Therapist | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2020-03-25 |
| 1710529714 | Dickovita Kankanamge Nirmani Tilakasena | Counselor | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2019-10-10 |
| 1568003978 | Sarah Lehman | Technician | 722 Ne 162nd Ave, Portland, OR 97230-5760 | 2019-10-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932687233 | Timisha K Wilson | Social Worker | 12505 Ne Halsey St, Portland, OR 97230 | 2018-07-30 |
| 1356828768 | Sally Gail Logan | Pharmacist | 5725 Ne 138th Avenue, Portland, OR 97230 | 2018-07-27 |
| 1063937951 | Marley Elizabeth Small | Counselor | 1507 Ne 122nd Ave., Portland, OR 97230 | 2017-08-11 |
| 1447771316 | Shadab Nasreen Aijazi | Pathology | 5220 Ne 122nd Avenue, Portland, OR 97230 | 2017-06-30 |
| 1104378199 | Derek Andrus | Pharmacist | 5717 Nw 138th, Portland, OR 97230 | 2016-10-26 |
| 1164972675 | Rachael Anderson | Adult Companion | 423 Ne 160th Ave #11, Portland, OR 97230 | 2016-10-07 |
| 1750837597 | Providence Elderplace | Assisted Living Facility | 16430 Ne Hoyt St, Portland, OR 97230 | 2016-08-31 |
| 1649622473 | Sara Mcgroarty | Counselor | 17710 Ne Halsey Street, Portland, OR 97230 | 2016-07-05 |
| 1346699949 | Steven D Stanton | Counselor | 1022 Ne 181st Ave, C1, Portland, OR 97230 | 2016-06-06 |
| 1215390091 | The Wallace Medical Concern | Clinic/Center | 18139 Ne Couch Street, Portland, OR 97230 | 2016-03-30 |
| Find all providers in zip 97230 | ||||
| Taxonomy Code | 164W00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Practical Nurse |
| An individual with post-high school vocational training and practical experience in the provision of nursing care at a level less than that required for certification as a Registered Nurse. Requirements for education, experience, licensure, and job responsibilities vary among the states. |
| Notes: Source: Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801448899 | David Terpea | Licensed Practical Nurse | 6920 Se Division St, Portland, OR 97206-1271 | 2019-07-10 |
| 1629565981 | Kufa Dekamo | Licensed Practical Nurse | 3708 Se 144th Ave, Portland, OR 97236-2731 | 2018-04-21 |
| 1740709658 | Alyssa M Cavalier | Licensed Practical Nurse | 6601 Ne 78th Ct., Suite A3, Portland, OR 97218 | 2017-09-12 |
| 1902344914 | Lacy Neal | Licensed Practical Nurse | 5737 Se Harold St, Portland, OR 97206-5526 | 2017-02-09 |
| 1720433691 | Megan Gauger | Licensed Practical Nurse | 3332 Se 7th Ave, Portland, OR 97202-2702 | 2016-04-28 |
| 1275993255 | Lauren Dodson | Licensed Practical Nurse | 324 Nw Davis St, Portland, OR 97209 | 2016-03-03 |
| 1285057083 | Kyle Epler | Licensed Practical Nurse | 4528 N 550 E, Portland, IN 47371-7956 | 2014-01-29 |
| 1902236813 | Laurie Cash | Licensed Practical Nurse | 8440 Fay St, Portland, NY 14769-9603 | 2013-11-14 |
| 1730436924 | Jonathan Edward Mondragon | Licensed Practical Nurse | 16141 E. Burnside St., Portland, OR 97233-3519 | 2012-08-07 |
| 1114299625 | Mai Nguyen | Licensed Practical Nurse | 3710 Southwest Veteran Hosp Road, Portland, OR 97239-2964 | 2012-01-30 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.