Healthcare Provider Details

I. General information

NPI: 1487352472
Provider Name (Legal Business Name): RASHA YAGHAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7833 JACQUELINE WAY
WHITE CITY OR
97503-1761
US

IV. Provider business mailing address

7833 JACQUELINE WAY
WHITE CITY OR
97503-1761
US

V. Phone/Fax

Practice location:
  • Phone: 505-524-4949
  • Fax: 505-944-1882
Mailing address:
  • Phone: 505-524-4949
  • Fax: 505-944-1882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53798
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number10019910
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number10019910
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number53798
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: