Provider Demographics
NPI:1285093591
Name:VESTAL, NORMA (ARNP)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:
Last Name:VESTAL
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:KUZANGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3181 S.W. SAM JACKSON PARK RD
Mailing Address - Street 2:ACADEMIC OFFICE, OP05-DC
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:971-280-2189
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-1226
Practice Address - Fax:503-346-6951
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9237559363LA2100X
WAAP60654996363LA2100X
OR201803489NP-PP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care