Healthcare Provider Details

I. General information

NPI: 1205081767
Provider Name (Legal Business Name): DANA M BRENDEN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANA M THOMAS

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 SE BELMONT ST FL 3
PORTLAND OR
97215-1675
US

IV. Provider business mailing address

13140 SW MADISON CT
BEAVERTON OR
97008-7759
US

V. Phone/Fax

Practice location:
  • Phone: 503-234-3400
  • Fax: 503-234-9424
Mailing address:
  • Phone: 503-579-6397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number200850090NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: