Provider Demographics
NPI:1962419721
Name:LYLE, SUZANNE WINDY (FNP)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:WINDY
Last Name:LYLE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:S.
Other - Middle Name:WINDY
Other - Last Name:LYLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1904 SE WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-2750
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:503-721-1077
Practice Address - Street 1:3710 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2964
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:503-721-1077
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily