Healthcare Provider Details

I. General information

NPI: 1326368648
Provider Name (Legal Business Name): HEATHER MARY SPONSEL LYTLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HEATHER MARY SPONSEL MD

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 03/19/2021
Certification Date: 03/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 MAY ST STE 202
HOOD RIVER OR
97031
US

IV. Provider business mailing address

PO BOX 3390
PORTLAND OR
97208-3390
US

V. Phone/Fax

Practice location:
  • Phone: 541-387-8940
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberQ0785
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60801530
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD199005
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: