Provider Demographics
NPI:1447431226
Name:CHANDLER, HOLLY BRITT (PA-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:BRITT
Last Name:CHANDLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9135 SW BARNES RD
Mailing Address - Street 2:STE 875
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-6683
Mailing Address - Country:US
Mailing Address - Phone:503-297-3440
Mailing Address - Fax:503-297-4584
Practice Address - Street 1:9135 SW BARNES RD STE 875
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6683
Practice Address - Country:US
Practice Address - Phone:503-297-3440
Practice Address - Fax:503-297-4584
Is Sole Proprietor?:No
Enumeration Date:2007-11-20
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA153701363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00478582OtherRAILROAD MEDICARE
102420OtherCONNECTICARE
0003554Medicare PIN