Provider Demographics
NPI:1720601966
Name:VANDERBURG HANNERS, EMELIA (PA-C)
Entity Type:Individual
Prefix:
First Name:EMELIA
Middle Name:
Last Name:VANDERBURG HANNERS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 SE 7TH AVE STE 5400
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4165
Mailing Address - Country:US
Mailing Address - Phone:503-648-0731
Mailing Address - Fax:503-640-2747
Practice Address - Street 1:333 SE 7TH AVE STE 5400
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4165
Practice Address - Country:US
Practice Address - Phone:503-648-0731
Practice Address - Fax:503-640-2747
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant