Provider Demographics
NPI:1639583891
Name:PETERS, LINDSAY ALLYSON
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:ALLYSON
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 SW GAINES ST
Mailing Address - Street 2:APT. B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3100
Mailing Address - Country:US
Mailing Address - Phone:971-409-0870
Mailing Address - Fax:
Practice Address - Street 1:304 PEARL ST
Practice Address - Street 2:
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-2684
Practice Address - Country:US
Practice Address - Phone:503-657-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion