Provider Demographics
NPI:1467458869
Name:POULSEN, LINDSEY C (PA-C)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:C
Last Name:POULSEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:C
Other - Last Name:WELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2650 SUZANNE WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97408-7619
Mailing Address - Country:US
Mailing Address - Phone:541-228-3100
Mailing Address - Fax:541-228-3107
Practice Address - Street 1:2650 SUZANNE WAY STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97408-7619
Practice Address - Country:US
Practice Address - Phone:541-228-3100
Practice Address - Fax:541-228-3107
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA223650363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209498Medicare ID - Type Unspecified
P51373Medicare UPIN