Provider Demographics
NPI:1194831248
Name:SEARLES, MONA (ANP , LAC)
Entity Type:Individual
Prefix:MS
First Name:MONA
Middle Name:
Last Name:SEARLES
Suffix:
Gender:F
Credentials:ANP , LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NE 20 TH AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-3094
Mailing Address - Country:US
Mailing Address - Phone:503-943-9842
Mailing Address - Fax:503-296-2482
Practice Address - Street 1:200 NE 20TH AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-3094
Practice Address - Country:US
Practice Address - Phone:503-943-9842
Practice Address - Fax:503-296-2482
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR083040868N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health