Provider Demographics
NPI:1669814711
Name:FRISSORA, KATHARINE MARY ELENA (DNP, PMHNP-BC, RN)
Entity Type:Individual
Prefix:DR
First Name:KATHARINE
Middle Name:MARY ELENA
Last Name:FRISSORA
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8459
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97207-8459
Mailing Address - Country:US
Mailing Address - Phone:503-238-0769
Mailing Address - Fax:
Practice Address - Street 1:10373 NE HANCOCK ST STE 200
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3873
Practice Address - Country:US
Practice Address - Phone:503-253-6754
Practice Address - Fax:503-253-8020
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15002NP363LP0808X
NYF401821363LP0808X
OR202003093NP-PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00695941Medicaid
OR500711757Medicaid
NYW6L111Medicare Oscar/Certification
NY331946Medicare Oscar/Certification
NY331043Medicare Oscar/Certification
NY331943Medicare Oscar/Certification
NY331009Medicare Oscar/Certification
NY331954Medicare Oscar/Certification
NY331945Medicare Oscar/Certification
NY331944Medicare Oscar/Certification
NY331947Medicare Oscar/Certification
NY00695941Medicaid
NY331952Medicare Oscar/Certification
NY331978Medicare Oscar/Certification