Healthcare Provider Details

I. General information

NPI: 1629602966
Provider Name (Legal Business Name): LINDSAY MORGAN ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 SE CARLTON ST
PORTLAND OR
97202-5414
US

IV. Provider business mailing address

1515 SE CARLTON ST
PORTLAND OR
97202-5414
US

V. Phone/Fax

Practice location:
  • Phone: 612-708-5565
  • Fax:
Mailing address:
  • Phone: 612-708-5565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number202000273RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: