=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770504763
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YAN DUAN ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2006
-----------------------------------------------------
Last Update Date | 06/17/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10250 SW GREENBURG RD 4 LINCOLN SUITE 110
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-5443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-293-4055
-----------------------------------------------------
Fax | 503-293-8332
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10250 SW GREENBURG RD 4 LINCOLN SUITE 110
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-5460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-293-4055
-----------------------------------------------------
Fax | 503-293-8332
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | PA401
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family
-----------------------------------------------------
License Number | 200750041NP FNP-PP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------