Healthcare Provider Details

I. General information

NPI: 1386752269
Provider Name (Legal Business Name): LYNN M VANTHOM P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LYNN M VANDEHEY THOMAS PA-C

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10670 NE CORNELL RD STE 300
HILLSBORO OR
97124-9221
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01316
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: