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1366136228
LISA DAWN THEOBALD
SALEM, OR
NPI
1366136228
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LP0808X Nurse Practitioner, Psych/Mental Health
(Licence: OR 10006245)
Enumeration Date
2023-06-05
Last Update Date
2024-03-13
Business Address
LISA DAWN THEOBALD PMHNP
2264 MCGILCHRIST ST SE STE 100
SALEM, OR 97302-1008
Phone number: 503-930-1812
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Mailing Address
LISA DAWN THEOBALD PMHNP
2264 MCGILCHRIST ST SE STE 100
SALEM, OR 97302-1008
Phone number:
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