Provider Demographics
NPI:1952451916
Name:ALBER, LYNETTE NAN (RN, PMHNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:NAN
Last Name:ALBER
Suffix:
Gender:F
Credentials:RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SW SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1300
Mailing Address - Country:US
Mailing Address - Phone:971-271-9432
Mailing Address - Fax:503-926-9173
Practice Address - Street 1:909 SW SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1300
Practice Address - Country:US
Practice Address - Phone:971-271-9432
Practice Address - Fax:503-926-9173
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650177NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR123190Medicaid