Provider Demographics
NPI:1639554637
Name:ANDERSON, PAIGE S (DNP)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:S
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:OP-02
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-6176
Mailing Address - Fax:503-494-6152
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:OP-02
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-6176
Practice Address - Fax:503-494-6152
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200940985RN163W00000X
OR201506273NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse