Healthcare Provider Details

I. General information

NPI: 1922504216
Provider Name (Legal Business Name): LINDSAY RAE OWEN CRM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N EVEREST ST STE A
NEWBERG OR
97132-2116
US

IV. Provider business mailing address

120 N EVEREST ST STE A
NEWBERG OR
97132-2116
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-7647
  • Fax: 503-538-9015
Mailing address:
  • Phone: 503-538-7647
  • Fax: 503-538-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number17-CRM-171
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: