Provider Demographics
NPI:1639271406
Name:LAFERRIERE, GINNY LEE (NP)
Entity Type:Individual
Prefix:MS
First Name:GINNY
Middle Name:LEE
Last Name:LAFERRIERE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:GINNY
Other - Middle Name:LEE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4515 NE ROYAL CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-2354
Mailing Address - Country:US
Mailing Address - Phone:503-235-5263
Mailing Address - Fax:
Practice Address - Street 1:2701 NW VAUGHN ST STE 160
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-5344
Practice Address - Country:US
Practice Address - Phone:503-499-5200
Practice Address - Fax:503-499-5455
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079043585N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health