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1790254399
LISA MARIE NYSTROM
PORTLAND, OR
NPI
1790254399
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: OR 201806297LPN)
Enumeration Date
2018-11-13
Last Update Date
2018-11-13
Business Address
Ms. LISA MARIE NYSTROM LPN
722 NE 162ND AVE
PORTLAND, OR 97230-5760
Phone number: 503-239-8101
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Mailing Address
Ms. LISA MARIE NYSTROM LPN
424 NE 22ND AVE
PORTLAND, OR 97232-2809
Phone number:
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