Healthcare Provider Details

I. General information

NPI: 1558836890
Provider Name (Legal Business Name): HANNAH GOODWATER-BATEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8645 SE SUNNYBROOK BLVD STE 200
CLACKAMAS OR
97015-6841
US

IV. Provider business mailing address

8645 SE SUNNYBROOK BLVD # 200
CLACKAMAS OR
97015-6841
US

V. Phone/Fax

Practice location:
  • Phone: 503-404-3907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number201809122NP-PP
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: