Healthcare Provider Details

I. General information

NPI: 1336110535
Provider Name (Legal Business Name): VICTORIA B. LAPORTE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 NE 122ND AVE
PORTLAND OR
97230-2011
US

IV. Provider business mailing address

PO BOX 92900
PORTLAND OR
97292-0900
US

V. Phone/Fax

Practice location:
  • Phone: 503-408-7010
  • Fax: 503-408-7035
Mailing address:
  • Phone: 503-408-7010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number000038375N1 FNP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0038375N1
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: