Healthcare Provider Details

I. General information

NPI: 1922090232
Provider Name (Legal Business Name): KAREN ANN RYDELL RN, ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN RYDELL RN, ANP

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6350 NE HALSEY ST
PORTLAND OR
97213-4720
US

IV. Provider business mailing address

1111 NE 99TH AVE SUITE 201
PORTLAND OR
97220-9442
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-2669
  • Fax: 503-215-8465
Mailing address:
  • Phone: 503-962-1000
  • Fax: 503-962-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number086000043N3 ANP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: