Provider Demographics
NPI:1316065667
Name:WEST, LYNN A (ANP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:A
Last Name:WEST
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:LYNN
Other - Middle Name:A
Other - Last Name:PFEIFLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP
Mailing Address - Street 1:5847 NE 122ND AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1079
Mailing Address - Country:US
Mailing Address - Phone:503-256-3401
Mailing Address - Fax:503-261-2600
Practice Address - Street 1:5847 NE 122ND AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1079
Practice Address - Country:US
Practice Address - Phone:503-256-3401
Practice Address - Fax:503-261-2600
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR80045812363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR016605Medicaid
OR118344Medicare ID - Type Unspecified
OR016605Medicaid