Provider Demographics
NPI:1538480918
Name:OSACHO, GERALD ANTHONY (ANP)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:ANTHONY
Last Name:OSACHO
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13210 SW HANSON LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-9605
Mailing Address - Country:US
Mailing Address - Phone:503-520-1638
Mailing Address - Fax:503-520-1638
Practice Address - Street 1:13210 SW HANSON LN
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-9605
Practice Address - Country:US
Practice Address - Phone:503-520-1638
Practice Address - Fax:503-520-1638
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-19
Last Update Date:2010-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR093006069N3363LA2200X
WAAP30004136363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health