Provider Demographics
NPI:1851899884
Name:POPP, LAUREN ALISE (FNP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ALISE
Last Name:POPP
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 SW BARNES RD STE 461
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6643
Mailing Address - Country:US
Mailing Address - Phone:503-216-1150
Mailing Address - Fax:971-282-0086
Practice Address - Street 1:9135 SW BARNES RD STE 461
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6643
Practice Address - Country:US
Practice Address - Phone:503-216-1150
Practice Address - Fax:971-282-0086
Is Sole Proprietor?:No
Enumeration Date:2018-01-24
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28203558A163WX0200X
OR201804844NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WX0200XNursing Service ProvidersRegistered NurseOncology