Basic Information
| Provider Information | |||||||||
| NPI: | 1871557983 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FROST | ||||||||
| FirstName: | LYNNE | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | ARNP, DNP, CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 PROSPECT AVE | ||||||||
| Address2: | |||||||||
| City: | HOOD RIVER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970311862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413993602 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 24850 SE STARK ST | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | GRESHAM | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970308318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034910714 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/14/2006 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0200X | 200150073NP | OR | Y | Nursing Service Providers | Registered Nurse | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 23YP05237NH01 | 01 | NH | BLUE SHIELD PROVIDER NUMB | OTHER |