Provider Demographics
NPI:1336102201
Name:SEVERIN, ANNA U (PA)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:U
Last Name:SEVERIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-2427
Mailing Address - Country:US
Mailing Address - Phone:503-873-6985
Mailing Address - Fax:
Practice Address - Street 1:1000 SE UGLOW AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-2645
Practice Address - Country:US
Practice Address - Phone:503-623-8376
Practice Address - Fax:503-623-5293
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00266363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR231084Medicaid
ORR96654Medicare UPIN
OR088WCGWZAMedicare ID - Type UnspecifiedMEDICARE