Basic Information
| Provider Information | |||||||||
| NPI: | 1639261142 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVERYWOMANS HEALTH PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 N GRAHAM | ||||||||
| Address2: | #445 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972272002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032845220 | ||||||||
| FaxNumber: | 5022492118 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 N GRAHAM | ||||||||
| Address2: | #445 | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972272002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032845220 | ||||||||
| FaxNumber: | 5022492118 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 02/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | HANSEN | ||||||||
| AuthorizedOfficialFirstName: | DEBRA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5032845220 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 076443 | 05 | OR | MEDICAID |