Provider Demographics
NPI:1497068621
Name:MCCASLIN-NOYES, DEIDRE SUE (LPN)
Entity type:Individual
Prefix:MS
First Name:DEIDRE
Middle Name:SUE
Last Name:MCCASLIN-NOYES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 SW ALDER ST
Mailing Address - Street 2:SUITE #300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-3133
Mailing Address - Country:US
Mailing Address - Phone:503-226-2203
Mailing Address - Fax:503-223-4231
Practice Address - Street 1:808 SW ALDER ST
Practice Address - Street 2:STE. #300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3133
Practice Address - Country:US
Practice Address - Phone:503-226-2203
Practice Address - Fax:503-223-4231
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR099003082LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR099003082LPNOtherSTATE OF OREGON NURSING LICENSE