Provider Demographics
NPI:1043479553
Name:DAHLKEMPER, ANNE AGNES (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:AGNES
Last Name:DAHLKEMPER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6941 N MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5431
Mailing Address - Country:US
Mailing Address - Phone:734-945-2147
Mailing Address - Fax:
Practice Address - Street 1:3181 SAM JACKSON PARK RD GH 219
Practice Address - Street 2:OHSU PA PROGRAM
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:734-945-2147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-09
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA153091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant