Healthcare Provider Details

I. General information

NPI: 1225314792
Provider Name (Legal Business Name): LYDIA C WARNER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/28/2011
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW BETHANY BLVD STE 200
BEAVERTON OR
97006-5236
US

IV. Provider business mailing address

PO BOX 239
ASTORIA OR
97103-0239
US

V. Phone/Fax

Practice location:
  • Phone: 503-708-0523
  • Fax: 844-813-1588
Mailing address:
  • Phone: 503-325-8315
  • Fax: 503-325-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberN360257589
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP011437
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201250017NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: