Provider Demographics
NPI:1417261066
Name:LAKELAND, VIOLET LAWTHER (FPMHNP-BC)
Entity Type:Individual
Prefix:
First Name:VIOLET
Middle Name:LAWTHER
Last Name:LAKELAND
Suffix:
Gender:F
Credentials:FPMHNP-BC
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:
Other - Last Name:LAKELAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8459
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1825 NE GLISAN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2844
Practice Address - Country:US
Practice Address - Phone:503-963-7676
Practice Address - Fax:503-764-9042
Is Sole Proprietor?:No
Enumeration Date:2010-08-05
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150162363LP0808X, 363LP0808X
CA95000184363LP0808X
CA846136163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse