Individual
DEBORAH M LASTINGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
12442 SW SCHOLLS FERRY RD, SUITE 100, TIGARD, OR 97223-3396
(503) 216-9900
(503) 216-9266
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
096006708N3
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500017837
RR MEDICARE
OR
Enumeration date
06/24/2006
Last updated
12/23/2013
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