Provider Demographics
NPI:1689677445
Name:KANDAS, EVONNE MARIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:EVONNE
Middle Name:MARIA
Last Name:KANDAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EVONNE
Other - Middle Name:MARIA
Other - Last Name:ANASIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:1130 NW 22ND AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2900
Mailing Address - Country:US
Mailing Address - Phone:503-413-8654
Mailing Address - Fax:503-413-8655
Practice Address - Street 1:1130 NW 22ND AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2900
Practice Address - Country:US
Practice Address - Phone:503-413-8654
Practice Address - Fax:503-413-8655
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR089000443N7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006647Medicaid
OR268963Medicaid
ORS73220Medicare UPIN
WA2006647Medicaid