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1619969771 NPI number — TAWNA RENEE PANGBORN FNP

NPI Number: 1619969771
Health Care Provider/Practitioner: TAWNA RENEE PANGBORN FNP

Information about “1619969771” NPI (TAWNA RENEE PANGBORN FNP) exists in 1619969771 in HTML format HTML  |  1619969771 in plain Text format TXT  |  1619969771 in PDF (Portable Document Format) PDF  |  1619969771 in an XML format XML  formats.

NPI Number : 1619969771 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619969771",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PANGBORN",
    "FirstName": "TAWNA",
    "MiddleName": "RENEE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ADAMS-PANGBORN",
    "OtherFirstName": "TAWNA",
    "OtherMiddleName": "RENEE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "541 NE 20TH AVE STE 225",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PORTLAND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97232-2895",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "503-963-2801",
    "MailingAddressFaxNumber": "503-963-2825",
    "FirstLinePracticeLocationAddress": "19250 SW 90TH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TUALATIN",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97062-7585",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "503-692-3750",
    "PracticeLocationAddressFaxNumber": "503-691-2324",
    "EnumerationDate": "08/16/2005",
    "LastUpdateDate": "10/02/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "200450062NP",
        "LicenseNumberStateCode": "OR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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