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General NPI Number Information
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NPI Number | 1396393518
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Entity Type | Individual
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Provider Name | KATHRYN AMANDA TROSEN
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Gender | Female
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Dates
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Enumeration Date | 08/30/2019
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Last Update Date | 08/30/2019
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Provider Practice Location Address
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Address Line | 1017 SW MORRISON ST STE 400
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City | PORTLAND
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State | OR
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Zip | 97205-2629
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Country | US
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Telephone | 503-224-3300
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Fax |
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Provider Business Mailing Address
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Address Line | 32700 SE LEEWOOD LN UNIT 27R
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City | BORING
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State | OR
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Zip | 97009-9530
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Country | US
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Telephone | 503-410-1751
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | BAP-E-10178089
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License Number State | OR
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