Provider Demographics
NPI:1700853173
Name:KAHANER, NANCY (DO)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:KAHANER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 SE 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4119
Mailing Address - Country:US
Mailing Address - Phone:503-771-1360
Mailing Address - Fax:503-777-1351
Practice Address - Street 1:5415 SE MILWAUKIE AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-4940
Practice Address - Country:US
Practice Address - Phone:503-233-6622
Practice Address - Fax:503-233-9988
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-03
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDO 15080207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR162255Medicaid
ORC90881Medicare UPIN
OR102408Medicare ID - Type Unspecified