Provider Demographics
NPI:1437491115
Name:RAINE, TERESSA ELIZABETH HAEFELE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:TERESSA
Middle Name:ELIZABETH HAEFELE
Last Name:RAINE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TERESSA
Other - Middle Name:ELIZABETH
Other - Last Name:HAEFELE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:847 NE 19TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2686
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:9155 SW BARNES RD STE 440
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-935-8500
Practice Address - Fax:503-935-8505
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-20
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA168447363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant