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General NPI Number Information
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NPI Number | 1710016050
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Entity Type | Individual
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Provider Name | TANNIA LYN FLEMING PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/04/2007
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Last Update Date | 02/03/2021
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Provider Practice Location Address
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Address Line | 3303 SW BOND AVE 8TH FLOOR
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City | PORTLAND
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State | OR
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Zip | 97239-4501
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Country | US
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Telephone | 503-494-9888
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Fax | 503-494-1760
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Provider Business Mailing Address
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Address Line | 3181 SW SAM JACKSON PARK RD SUITE 2360
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City | PORTLAND
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State | OR
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Zip | 97239-3011
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Country | US
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Telephone | 503-494-6406
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Fax | 503-494-5050
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01209
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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