Individual
KATHERINE LATTIMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
U
Credential
PMHNP-BC
Contact information
Practice address
4212 NE BROADWAY, PORTLAND, OR 97213-1422
(503) 249-8787
Mailing address
2216 NE 21ST AVE, PORTLAND, OR 97212-4622
(503) 701-4880
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201403853RN
OR
163WE0003X
Emergency Registered Nurse
201403853RN
OR
163WP0808X
Psychiatric/Mental Health Registered Nurse
201403853RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10005847
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10005847
OREGON STATE BOARD OF NURSING
OR
01
—
201403853RN
OREGON STATE BOARD OF NURSING
OR
Enumeration date
07/09/2019
Last updated
07/25/2024
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