Provider Demographics
NPI:1710266226
Name:BROWN, ANNE (PMHNP)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:
Other - Last Name:STARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:2165 SW MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-1123
Mailing Address - Country:US
Mailing Address - Phone:503-915-1334
Mailing Address - Fax:503-296-2643
Practice Address - Street 1:2165 SW MAIN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-1123
Practice Address - Country:US
Practice Address - Phone:503-915-1334
Practice Address - Fax:503-296-2643
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200942680RN163WA0400X
OR201150100NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR22959Medicaid
OR474259OtherREGENCE