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Individual

MS. KATHLEEN M MEDWAR

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP

Contact information

Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7772
(503) 418-3283
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7772
(503) 418-3283

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201350062NP
OR
363LF0000X
Family Nurse Practitioner
2263944
MA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0000023532
BMC
MA
01
042611055
TAX ID
MA
01
1004745
NHP
MA
01
1303287
MBHP
MA
05
1303287
MA
05
500679358
OR
01
99618201
NETWORK HEALTH
MA
01
M18633
BCBS
MA
Enumeration date
04/04/2011
Last updated
07/25/2023
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