Individual
KATHLEEN IRENE RODENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-6613
Mailing address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5520
(503) 906-6613
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA205646
OR
363AS0400X
Surgical Physician Assistant
Primary
PA205646
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA205646
PA LICENSE
OR
Enumeration date
09/30/2015
Last updated
12/22/2021
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