Provider Demographics
NPI:1174064802
Name:GUSTAFSON, LINDSEY CAMPBELL (FNP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:CAMPBELL
Last Name:GUSTAFSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LINDSEY
Other - Middle Name:MARSHALL
Other - Last Name:CAMPBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 1517
Mailing Address - Street 2:
Mailing Address - City:PENDLETON
Mailing Address - State:OR
Mailing Address - Zip Code:97801-0410
Mailing Address - Country:US
Mailing Address - Phone:877-708-1119
Mailing Address - Fax:541-278-8349
Practice Address - Street 1:13200 SW PACIFIC HWY
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-4828
Practice Address - Country:US
Practice Address - Phone:503-598-2000
Practice Address - Fax:503-639-0920
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60741544363LF0000X
OR201700303NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily