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General NPI Number Information
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NPI Number | 1992797039
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Entity Type | Individual
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Provider Name | CYNTHIA ANN BOHAN PAC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 507 NE 47TH AVE SUITE 200
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City | PORTLAND
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State | OR
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Zip | 97213-2236
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Country | US
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Telephone | 503-215-2300
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Fax | 503-215-2283
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Provider Business Mailing Address
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Address Line | 975 SE SANDY BLVD SUITE 200
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City | PORTLAND
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State | OR
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Zip | 97214-1308
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Country | US
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Telephone | 503-963-2846
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Fax | 503-963-9505
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA01008
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License Number State | OR
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