Provider Demographics
NPI:1376849323
Name:VO-DINH, KATHERINE PHUONG-NAM (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:PHUONG-NAM
Last Name:VO-DINH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:VO-DINH
Other - Last Name:LOLLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:11155 NE HALSEY STREET
Mailing Address - Street 2:ROSE CITY URGENT CARE AND FAMILY PRACTICE
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220
Mailing Address - Country:US
Mailing Address - Phone:503-894-9005
Mailing Address - Fax:805-564-5087
Practice Address - Street 1:11155 NE HALSEY STREET
Practice Address - Street 2:ROSE CITY URGENT CARE AND FAMILY PRACTICE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220
Practice Address - Country:US
Practice Address - Phone:707-826-8264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR116411163W00000X
OR201350063NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MV2504997NP201350063OtherDEA ORNP