Provider Demographics
NPI:1083759898
Name:DANFORTH, PATRICIA JEAN (CANP)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:JEAN
Last Name:DANFORTH
Suffix:
Gender:F
Credentials:CANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 450
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103
Mailing Address - Country:US
Mailing Address - Phone:503-325-3935
Mailing Address - Fax:503-325-3938
Practice Address - Street 1:2055 EXCHANGE STREET
Practice Address - Street 2:SUITE 210
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103
Practice Address - Country:US
Practice Address - Phone:503-325-3935
Practice Address - Fax:503-325-3938
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR00038357363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR114608Medicaid
ORS00434Medicare UPIN
OR114608Medicaid