Healthcare Provider Details

I. General information

NPI: 1164879086
Provider Name (Legal Business Name): LINDSAY DIANNE JESTER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2016
Last Update Date: 10/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E FOURTH PLAIN BLVD
VANCOUVER WA
98661-3713
US

IV. Provider business mailing address

14600 NW CORNELL RD
PORTLAND OR
97229-5442
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-8246
  • Fax:
Mailing address:
  • Phone: 503-645-3581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201803619RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN60650537
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: