Healthcare Provider Details

I. General information

NPI: 1255363750
Provider Name (Legal Business Name): PAMELA J. RATHBONE WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 02/01/2026
Certification Date: 02/01/2026
Deactivation Date: 10/10/2024
Reactivation Date: 11/19/2024

III. Provider practice location address

4140 SW 19TH CT
GRESHAM OR
97080-8351
US

IV. Provider business mailing address

4140 SW 19TH CT
GRESHAM OR
97080-8351
US

V. Phone/Fax

Practice location:
  • Phone: 971-235-4335
  • Fax:
Mailing address:
  • Phone: 971-235-4335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number092006979N7
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number092006979RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: