Provider Demographics
NPI:1326692708
Name:WYSTRACH, LIA ARMSTRONG (BSN, RN, MN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LIA
Middle Name:ARMSTRONG
Last Name:WYSTRACH
Suffix:
Gender:F
Credentials:BSN, RN, MN, FNP-C
Other - Prefix:
Other - First Name:LIA
Other - Middle Name:MARGUERITE
Other - Last Name:ARMSTRONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4114 NE ROYAL CT APT A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2677
Mailing Address - Country:US
Mailing Address - Phone:650-576-2558
Mailing Address - Fax:
Practice Address - Street 1:10151 SE SUNNYSIDE RD STE 100
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6913
Practice Address - Country:US
Practice Address - Phone:503-659-0880
Practice Address - Fax:503-513-7425
Is Sole Proprietor?:No
Enumeration Date:2019-07-24
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201906215NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily