Provider Demographics
NPI:1508232448
Name:LOUISELL, ANDREA (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:LOUISELL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:
Other - Last Name:GATTUSO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5406 SW FLORIDA ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-1300
Mailing Address - Country:US
Mailing Address - Phone:503-476-7727
Mailing Address - Fax:
Practice Address - Street 1:4015 MERCANTILE DR STE 200
Practice Address - Street 2:SUITE 200
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-2552
Practice Address - Country:US
Practice Address - Phone:503-216-1538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-14
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200242256363LF0000X
OR201507030NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily