Organization
PORTLAND VA MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LYNETTE KAPUALANI WATTS GNP (GERIATRIC NURSE PRACTITIONER)
(503) 237-0153
Entity
Organization
Contact information
Practice address
1601 E FOURTH PLAIN BLVD, VANCOUVER, WA 98661-3753
(503) 220-8262
Mailing address
21950 S UPPER HIGHLAND RD, BEAVERCREEK, OR 97004-8810
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
060018996N3ANP/GNP
OR
Other
Enumeration date
09/25/2006
Last updated
08/14/2008
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