Healthcare Provider Details

I. General information

NPI: 1073027447
Provider Name (Legal Business Name): CHRISTINE E GUPPENBERGER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2017
Last Update Date: 02/09/2026
Certification Date: 02/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 NE 99TH AVE STE 100
PORTLAND OR
97220-9437
US

IV. Provider business mailing address

1321 NE 99TH AVE STE 100
PORTLAND OR
97220-9437
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-9900
  • Fax:
Mailing address:
  • Phone: 503-215-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA185224
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA185224
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: