Healthcare Provider Details

I. General information

NPI: 1831681618
Provider Name (Legal Business Name): RYAN HERMANSEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9427 SW BARNES RD STE 495
PORTLAND OR
97225-6612
US

IV. Provider business mailing address

9427 SW BARNES RD STE 495
PORTLAND OR
97225-6612
US

V. Phone/Fax

Practice location:
  • Phone: 503-814-4440
  • Fax: 503-814-4444
Mailing address:
  • Phone: 971-238-9767
  • Fax: 971-228-1709

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number14301822-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA194995
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA61585177
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: