Individual
LORELYN FERNWEH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2180 NE 47TH AVE APT 501, PORTLAND, OR 97213-2093
(503) 307-1458
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01180
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500605528
—
OR
Enumeration date
01/23/2007
Last updated
03/24/2023
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