Individual
MR. TIMOTHY J LAFOLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
6309 SE 86TH AVE, PORTLAND, OR 97266-5464
(503) 389-5366
Mailing address
PO BOX 66722, PORTLAND, OR 97290-6722
(503) 389-5366
(866) 635-1779
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201042898RN
OR
163W00000X
Registered Nurse
RN60302047
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201250134NP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
AP60302050
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2022839
—
WA
05
—
500649528
—
OR
Enumeration date
05/29/2011
Last updated
03/05/2024
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