Basic Information
| Provider Information | |||||||||
| NPI: | 1376849323 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VO-DINH | ||||||||
| FirstName: | KATHERINE | ||||||||
| MiddleName: | PHUONG-NAM | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LOLLAR | ||||||||
| OtherFirstName: | KATHERINE | ||||||||
| OtherMiddleName: | VO-DINH | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | FNP-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11155 NE HALSEY STREET | ||||||||
| Address2: | ROSE CITY URGENT CARE AND FAMILY PRACTICE | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038949005 | ||||||||
| FaxNumber: | 8055645087 | ||||||||
| Practice Location | |||||||||
| Address1: | 11155 NE HALSEY STREET | ||||||||
| Address2: | ROSE CITY URGENT CARE AND FAMILY PRACTICE | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7078268264 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2011 | ||||||||
| LastUpdateDate: | 01/06/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R116411 | MD | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 201350063NP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | MV2504997NP201350063 | 01 | DEA ORNP | OTHER |