| Doctor Name: | LISA MARIE RIESTERER |
| NPI Number: | 1053715326 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP, DNP |
| License Number: | 201392419NP-PP |
| Business Practice Address: | 1175 Mount Hood Ave Woodburn, OR - 970719060 |
| Business Phone Number: | 5039822000 |
| Business Fax Number: | 5039820660 |
| Mailing Address: | Po Box 190, TOPPENISH |
| State: | WA |
| Postal Code: | 989480190 |
| Phone Number: | 5098652395 |
| Fax Number: | 5098650757 |
| NPI Enumeration Date: | 10/15/2014 |
| NPI Last Update Date: | 12/03/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 201392419NP-PP |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |