Healthcare Provider Details

I. General information

NPI: 1164086021
Provider Name (Legal Business Name): MRS. LINDSAY ANN MARSHALL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSAY URBAN

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 11/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18765 SW BOONES FERRY RD
TUALATIN OR
97062-8496
US

IV. Provider business mailing address

2822 41ST ST
LUBBOCK TX
79413-3208
US

V. Phone/Fax

Practice location:
  • Phone: 503-612-1000
  • Fax:
Mailing address:
  • Phone: 254-855-3468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201901265NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: