Provider Demographics
NPI:1467718908
Name:IWAN, KATARZYNA BARBARA (MD)
Entity Type:Individual
Prefix:DR
First Name:KATARZYNA
Middle Name:BARBARA
Last Name:IWAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9925 SW NIMBUS AVE
Mailing Address - Street 2:#100
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-7591
Mailing Address - Country:US
Mailing Address - Phone:503-535-8302
Mailing Address - Fax:855-276-2456
Practice Address - Street 1:9925 SW NIMBUS AVE
Practice Address - Street 2:#100
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-7591
Practice Address - Country:US
Practice Address - Phone:503-535-8302
Practice Address - Fax:855-276-2456
Is Sole Proprietor?:No
Enumeration Date:2012-04-10
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD189597208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500753304Medicaid