Healthcare Provider Details

I. General information

NPI: 1477216950
Provider Name (Legal Business Name): TENZIN TSERING LAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 SE STARK ST STE 205
GRESHAM OR
97030-3382
US

IV. Provider business mailing address

4117 NW 12TH AVE
CAMAS WA
98607-7996
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number202112498
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10034016
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number10034016
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: