1659554244 NPI number — MS. LINDSEY S NELSON N.D.

Table of content: MS. LINDSEY S NELSON N.D. (NPI 1659554244)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659554244 NPI number — MS. LINDSEY S NELSON N.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
LINDSEY
Provider Middle Name:
S
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
N.D.
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:
1659554244
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2766 SW FAIRVIEW BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97205-5825
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-201-1350
Provider Business Mailing Address Fax Number:
833-453-1594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2766 SW FAIRVIEW BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97205-5825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-201-1350
Provider Business Practice Location Address Fax Number:
833-453-1594
Provider Enumeration Date:
12/06/2007

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: 175F00000X , with the licence number:  1348 , 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: 019388004 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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