Healthcare Provider Details

I. General information

NPI: 1437191368
Provider Name (Legal Business Name): LINDSEY LEE HERN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY LEE HUNT PA-C

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9135 SW BARNES RD STE 963
PORTLAND OR
97225-6699
US

IV. Provider business mailing address

9135 SW BARNES RD STE 963
PORTLAND OR
97225-6699
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-1419
  • Fax: 503-216-2488
Mailing address:
  • Phone: 503-297-1419
  • Fax: 503-216-2488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number010733
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA01312
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: