Provider Demographics
NPI:1225314792
Name:WARNER, LYDIA C (FNP-BC)
Entity Type:Individual
Prefix:
First Name:LYDIA
Middle Name:C
Last Name:WARNER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 239
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-0239
Mailing Address - Country:US
Mailing Address - Phone:503-325-8315
Mailing Address - Fax:503-325-8602
Practice Address - Street 1:1500 NW BETHANY BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-5236
Practice Address - Country:US
Practice Address - Phone:503-708-0523
Practice Address - Fax:844-813-1588
Is Sole Proprietor?:No
Enumeration Date:2011-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAN360257589363LF0000X
PASP011437363LF0000X
OR201250017NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231893Medicaid