Healthcare Provider Details

I. General information

NPI: 1689677445
Provider Name (Legal Business Name): EVONNE MARIA KANDAS N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EVONNE MARIA ANASIS N.P.

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 NW 22ND AVE SUITE 110
PORTLAND OR
97210-2900
US

IV. Provider business mailing address

1130 NW 22ND AVE SUITE 110
PORTLAND OR
97210-2900
US

V. Phone/Fax

Practice location:
  • Phone: 503-413-8654
  • Fax: 503-413-8655
Mailing address:
  • Phone: 503-413-8654
  • Fax: 503-413-8655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number089000443N7
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: