Healthcare Provider Details

I. General information

NPI: 1336297985
Provider Name (Legal Business Name): LORI LYNETTE LINTON NELSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 CENTER ST NE
SALEM OR
97301-4532
US

IV. Provider business mailing address

27332 S MERIDIAN RD
AURORA OR
97002-8314
US

V. Phone/Fax

Practice location:
  • Phone: 503-588-5351
  • Fax: 503-585-4908
Mailing address:
  • Phone: 503-678-6946
  • Fax: 503-585-4908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number086000481N6-PMHNP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: