Provider Demographics
NPI:1447026646
Name:GWARDYS, TUYET LAM (NP)
Entity type:Individual
Prefix:
First Name:TUYET
Middle Name:LAM
Last Name:GWARDYS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 SW 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-3604
Mailing Address - Country:US
Mailing Address - Phone:480-235-5180
Mailing Address - Fax:
Practice Address - Street 1:111 SW 5TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97204-3604
Practice Address - Country:US
Practice Address - Phone:480-235-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10018844363LP0808X
AZ299235363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health