Healthcare Provider Details

I. General information

NPI: 1831509439
Provider Name (Legal Business Name): MRS. ANDREA KUCHLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD MAIL CODE SJH-2
PORTLAND OR
97239
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-7641
  • Fax: 503-494-4661
Mailing address:
  • Phone: 503-494-4910
  • Fax: 503-494-8368

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA174418
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA174418
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: