Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD186799 | OR |
Y | 111NI0900X | Internist | MD186799 | OR |
N | 207RG0300X | Geriatric Medicine | MD186799 | OR |
NPI | 1093128571 |
---|---|
Provider Name | Lisa Kendell Sanders |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-2985 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 15/02/2021 |