Provider Demographics
NPI:1508899790
Name:RESSLER, KATHLEEN A (NP)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:A
Last Name:RESSLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:KATHLEEN
Other - Middle Name:A
Other - Last Name:INGRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:14450 SE ROYER RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:OR
Mailing Address - Zip Code:97089-8730
Mailing Address - Country:US
Mailing Address - Phone:503-658-5521
Mailing Address - Fax:503-658-5002
Practice Address - Street 1:14450 SE ROYER RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:OR
Practice Address - Zip Code:97089-8730
Practice Address - Country:US
Practice Address - Phone:503-658-5521
Practice Address - Fax:503-658-5002
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200250163NPFNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR140251Medicare PIN