Healthcare Provider Details

I. General information

NPI: 1346518370
Provider Name (Legal Business Name): ANNIE J BARLOW PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE J BERGER PA-C

II. Dates (important events)

Enumeration Date: 12/05/2011
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 S BOND AVE
PORTLAND OR
97239-4501
US

IV. Provider business mailing address

6241 15TH AVE S
RICHFIELD MN
55423-1739
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-6597
  • Fax: 503-494-5385
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11439
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberEL11534
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number6661176
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA218233
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: