Basic Information
| Provider Information | |||||||||
| NPI: | 1104970508 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUERBACH | ||||||||
| FirstName: | ROMNEE | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | ANP-BC,PMHS,PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971322909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5035384874 | ||||||||
| FaxNumber: | 5035381271 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 E 1ST ST | ||||||||
| Address2: | |||||||||
| City: | NEWBERG | ||||||||
| State: | OR | ||||||||
| PostalCode: | 971322909 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033784874 | ||||||||
| FaxNumber: | 5033781271 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2007 | ||||||||
| LastUpdateDate: | 12/24/2015 | ||||||||
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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 | 363LP0808X | 200650168NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 363LA2200X | 088000343N3 | OR | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | 165554 | 05 | OR | MEDICAID |