Provider Demographics
NPI:1467548669
Name:PFAFF, EMILY (PA)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PFAFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 9TH ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:OR
Mailing Address - Zip Code:97439-9470
Mailing Address - Country:US
Mailing Address - Phone:541-997-7134
Mailing Address - Fax:
Practice Address - Street 1:380 9TH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:OR
Practice Address - Zip Code:97439-9470
Practice Address - Country:US
Practice Address - Phone:541-997-7134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA163405363AM0700X
WAPA10003872363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
23796OtherGROUP HEALTH
WA8401648Medicaid
OR500660264Medicaid
ORPA163405OtherSTATE LICENSE
WA0134671OtherL & I
911019392OtherCOMMERCIAL
WA8401648OtherCHPW
PF7279OtherREGENCE
PF7279OtherREGENCE
ORR171932Medicare PIN