Healthcare Provider Details

I. General information

NPI: 1467980961
Provider Name (Legal Business Name): GIANNA N O'HARA DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2017
Last Update Date: 08/10/2025
Certification Date: 08/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13898 NE 28TH ST
VANCOUVER WA
98682-8844
US

IV. Provider business mailing address

13898 NE 28TH ST
VANCOUVER WA
98682-8844
US

V. Phone/Fax

Practice location:
  • Phone: 360-397-3352
  • Fax: 360-397-3206
Mailing address:
  • Phone: 360-397-3352
  • Fax: 360-397-3206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberR2826
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberR2826
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberDO219746
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number18033
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberOP61041037
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: