# PORTLAND VA MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588765523
- **Authorized official:** MRS. LYNETTE KAPUALANI WATTS GNP (GERIATRIC NURSE PRACTITIONER)
- **Authorized official phone:** (503) 237-0153

## Contact information

- **Practice address:** 1601 E FOURTH PLAIN BLVD, VANCOUVER, WA 98661-3753
- **Practice address phone:** (503) 220-8262
- **Mailing address:** 21950 S UPPER HIGHLAND RD, BEAVERCREEK, OR 97004-8810

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 060018996N3ANP/GNP | OR | Yes |

## Other

- **Enumeration date:** 09/25/2006
- **Last updated:** 08/14/2008