MEDICARE: INGRID FLANDERS FNP

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
1	363LF0000X	Family Nurse Practitioner	200350092NP	OR
2	363LP2300X	Primary Care Nurse Practitioner	200350092NP	OR
3	363LP2300X	Primary Care Nurse Practitioner	AP30006571	WA
4	363LF0000X	Family Nurse Practitioner	AP30006571	WA

General Provider Information

NPI Number	:	1649272550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRID FLANDERS FNP

Provider Business Mailing Address
First Line	:	3360 NE 133RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-2811
Country	:	US
Telephone Number	:	541-991-0171
Fax Number	:

Provider Business Practice Location Address
First Line	:	3360 NE 133RD AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230-2811
Country	:	US
Telephone Number	:	541-991-0171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/16/2024

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