Provider Demographics
NPI:1700072220
Name:FREDERICKS, LINDA JOYCE THIMSEN (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JOYCE THIMSEN
Last Name:FREDERICKS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:JOYCE
Other - Last Name:THIMSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:503-215-6644
Practice Address - Street 1:1321 NE 99TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9437
Practice Address - Country:US
Practice Address - Phone:503-215-9900
Practice Address - Fax:503-215-4025
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR095006223N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily