Healthcare Provider Details

I. General information

NPI: 1346601754
Provider Name (Legal Business Name): KATHERINE O SPIRA DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2016
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3303 SW BOND AVE STE 9
PORTLAND OR
97239
US

IV. Provider business mailing address

3303 SW BOND AVE STE 9
PORTLAND OR
97239-4501
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8573
  • Fax:
Mailing address:
  • Phone: 503-494-8573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201800777NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.0200907
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number201800605RN
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0992575-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: