Healthcare Provider Details

I. General information

NPI: 1699594200
Provider Name (Legal Business Name): ALYSSA R. LIND PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2024
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1976 GARDEN AVE
EUGENE OR
97403-1933
US

IV. Provider business mailing address

1976 GARDEN AVE
EUGENE OR
97403-1933
US

V. Phone/Fax

Practice location:
  • Phone: 541-255-1411
  • Fax: 541-255-1412
Mailing address:
  • Phone: 541-255-1411
  • Fax: 541-255-1412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10033926
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: