Provider Demographics
NPI:1619969771
Name:PANGBORN, TAWNA RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:TAWNA
Middle Name:RENEE
Last Name:PANGBORN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TAWNA
Other - Middle Name:RENEE
Other - Last Name:ADAMS-PANGBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19260 SW 65TH AVE
Mailing Address - Street 2:SUITE 435
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-5701
Mailing Address - Country:US
Mailing Address - Phone:503-692-2032
Mailing Address - Fax:503-692-4450
Practice Address - Street 1:19260 SW 65TH AVE
Practice Address - Street 2:SUITE 435
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5701
Practice Address - Country:US
Practice Address - Phone:503-692-2032
Practice Address - Fax:503-692-4450
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2018-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450062NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1060461Medicaid
OR213419Medicaid
ORR141386Medicare PIN
ORQ47208Medicare UPIN
WAG8894762Medicare PIN