Healthcare Provider Details

I. General information

NPI: 1609185107
Provider Name (Legal Business Name): LINDSEY M. BERSON NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDSEY M. MUELLER

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 02/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19005 SE 34TH ST
VANCOUVER WA
98683-1450
US

IV. Provider business mailing address

19005 SE 34TH ST
VANCOUVER WA
98683-1450
US

V. Phone/Fax

Practice location:
  • Phone: 360-726-6720
  • Fax: 360-726-6729
Mailing address:
  • Phone: 360-726-6720
  • Fax: 360-726-6729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008333
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60871306
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: