Healthcare Provider Details

I. General information

NPI: 1780914788
Provider Name (Legal Business Name): RENA APON CRNA, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/13/2010
Last Update Date: 01/23/2023
Certification Date: 01/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12150 SW 1ST ST
BEAVERTON OR
97005-2850
US

IV. Provider business mailing address

12150 SW 1ST ST
BEAVERTON OR
97005-2850
US

V. Phone/Fax

Practice location:
  • Phone: 503-530-8521
  • Fax:
Mailing address:
  • Phone: 503-530-8521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number98232
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201060015CRNA
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number095000250
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202211131NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: