1306392527 NPI number — LORI-ANN LIMA RN, FNP-C

Table of content: LORI-ANN LIMA RN, FNP-C (NPI 1306392527)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306392527 NPI number — LORI-ANN LIMA RN, FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIMA
Provider First Name:
LORI-ANN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306392527
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
421 SW OAK ST
Provider Second Line Business Mailing Address:
STE. 210
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97204-1817
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-988-7468
Provider Business Mailing Address Fax Number:
503-988-3015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MULTNOMAH COUNTY HEALTH DEPARTMENT- MID CTY HEALTH CTR
Provider Second Line Business Practice Location Address:
12710 SE DIVISION ST
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97236
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-988-3601
Provider Business Practice Location Address Fax Number:
503-988-4144
Provider Enumeration Date:
08/28/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  201606124NP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 096511 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 022959 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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