Provider Demographics
NPI:1891234399
Name:NGUYEN, LILLIAN
Entity type:Individual
Prefix:
First Name:LILLIAN
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5835 NE 122ND AVE STE 160
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97230-1057
Mailing Address - Country:US
Mailing Address - Phone:503-251-6301
Mailing Address - Fax:
Practice Address - Street 1:5835 NE 122ND AVE STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97230-1057
Practice Address - Country:US
Practice Address - Phone:503-251-6192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2024-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61536070363LF0000X
OR201707542RN163W00000X
WARN61042763163W00000X
OR10023687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse