Provider Demographics
NPI:1619125341
Name:VANLUE, LEA DM (PA-C)
Entity type:Individual
Prefix:
First Name:LEA
Middle Name:DM
Last Name:VANLUE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1916
Mailing Address - Country:US
Mailing Address - Phone:503-873-8686
Mailing Address - Fax:503-873-8689
Practice Address - Street 1:861 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MOLALLA
Practice Address - State:OR
Practice Address - Zip Code:97038-9352
Practice Address - Country:US
Practice Address - Phone:503-829-7344
Practice Address - Fax:503-829-7374
Is Sole Proprietor?:No
Enumeration Date:2008-09-06
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR152814363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant