Provider Demographics
NPI:1205658150
Name:LINDVALL, RUTH (PMHNP)
Entity type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:LINDVALL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:RUTHY
Other - Middle Name:
Other - Last Name:LINDVALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP
Mailing Address - Street 1:3439 SE HAWTHORNE BLVD STE 955
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-5048
Mailing Address - Country:US
Mailing Address - Phone:541-231-1135
Mailing Address - Fax:
Practice Address - Street 1:3439 SE HAWTHORNE BLVD STE 955
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5048
Practice Address - Country:US
Practice Address - Phone:541-231-1135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-30
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10034641363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health