Provider Demographics
NPI:1417276080
Name:CAIN, DEANNA (PMHNP, CNS)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:CAIN
Suffix:
Gender:F
Credentials:PMHNP, CNS
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:
Other - Last Name:BARNEY CAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP, CNS
Mailing Address - Street 1:6647 SE MILWAUKIE AVE
Mailing Address - Street 2:SUITE B210
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5651
Mailing Address - Country:US
Mailing Address - Phone:503-432-0216
Mailing Address - Fax:971-200-2719
Practice Address - Street 1:6647 SE MILWAUKIE AVE
Practice Address - Street 2:SUITE B210
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5651
Practice Address - Country:US
Practice Address - Phone:503-432-0216
Practice Address - Fax:971-200-2719
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-21
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950005NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health