Provider Demographics
NPI:1467075846
Name:CLOTHIER, ANANDA MIKAEL (FNP)
Entity Type:Individual
Prefix:MR
First Name:ANANDA
Middle Name:MIKAEL
Last Name:CLOTHIER
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:MIKAEL
Other - Middle Name:
Other - Last Name:CLOTHIER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:3455 SW US VETERANS HOSPITAL RD
Mailing Address - Street 2:SCHOOL OF NURSING PORTLAND CAMPUS
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3076
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3455 SW US VETERANS HOSPITAL RD
Practice Address - Street 2:SCHOOL OF NURSING PORTLAND CAMPUS
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3076
Practice Address - Country:US
Practice Address - Phone:503-494-7444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202214935NP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily