Healthcare Provider Details

I. General information

NPI: 1164910725
Provider Name (Legal Business Name): KATHERINE ANNE MCDUFFEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2018
Last Update Date: 07/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18840 SW BOONES FERRY RD
TUALATIN OR
97062
US

IV. Provider business mailing address

11009 SW AUSTRIA LOOP
WILSONVILLE OR
97070-2006
US

V. Phone/Fax

Practice location:
  • Phone: 503-332-1251
  • Fax:
Mailing address:
  • Phone: 503-332-1251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201802489
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: