Provider Demographics
NPI:1699820027
Name:POPPER, DEBORAH K (ANP, WHCNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:K
Last Name:POPPER
Suffix:
Gender:F
Credentials:ANP, WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 NW 22ND AVE STE LL10
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-2974
Mailing Address - Country:US
Mailing Address - Phone:503-413-8050
Mailing Address - Fax:503-413-7491
Practice Address - Street 1:1130 NW 22ND AVE STE LL10
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2974
Practice Address - Country:US
Practice Address - Phone:503-413-8050
Practice Address - Fax:503-413-7491
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200550148NP363LA2200X
OR200350117NP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health