Most Relevant Information
Provider Data
| NPI Number: | 1003382169 |
| Provider Name: | DEVIN ALEX LISDERO |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 10/16/2018 |
| Last Updated: | 10/16/2018 |
Provider Practice Location
422 NE 5TH ST
MCMINNVILLE
OR
971284604
Practice Location Phone/Fax
| Phone: | 5034724020 |
| Fax: |
Provider Mailing Location
422 NE 5TH ST
MCMINNVILLE
OR
971284604
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |