Provider Demographics
NPI:1710133764
Name:RYNEARSON, SAMANTHA SEARCY (PMHNP-BC, CNM, MN)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SEARCY
Last Name:RYNEARSON
Suffix:
Gender:F
Credentials:PMHNP-BC, CNM, MN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E 2ND ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3083
Mailing Address - Country:US
Mailing Address - Phone:503-427-8581
Mailing Address - Fax:503-461-0061
Practice Address - Street 1:200 E 2ND ST STE 102
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-3083
Practice Address - Country:US
Practice Address - Phone:503-427-8581
Practice Address - Fax:503-461-0061
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202007260NP363LP0808X
OR200850104NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR144441Medicare PIN