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NPI Code Detail

MEDICARE: VIOLET LAWTHER LAKELAND FPMHNP-BC

MEDICARE: VIOLET LAWTHER LAKELAND FPMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner201150162OR

General Provider Information

NPI Number : 1417261066
Entity Type Code : Individual
Provider Name (Legal Business Name) : VIOLET LAWTHER LAKELAND FPMHNP-BC
Provider Business Mailing Address
First Line : PO BOX 8459
Second Line :
City : PORTLAND
State : OR
Zip : 97207-8459
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1825 NE GLISAN ST
Second Line :
City : PORTLAND
State : OR
Zip : 97232-2844
Country : US
Telephone Number : 503-963-7676
Fax Number : 503-764-9042
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/05/2010
Last Update Date : 01/19/2023

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