Provider Demographics
NPI:1164829578
Name:NATH, DEBDEEP (NP)
Entity Type:Individual
Prefix:
First Name:DEBDEEP
Middle Name:
Last Name:NATH
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 SW 2ND ST STE 150
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2846
Mailing Address - Country:US
Mailing Address - Phone:971-334-1381
Mailing Address - Fax:503-300-5388
Practice Address - Street 1:12225 SW 2ND ST STE 150
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005
Practice Address - Country:US
Practice Address - Phone:971-334-1381
Practice Address - Fax:503-300-5388
Is Sole Proprietor?:No
Enumeration Date:2014-12-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201606039NP-PP363LP0200X, 363L00000X
OR201601196RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse