Provider Demographics
NPI:1730302076
Name:IVERSEN, DEANI KAY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEANI
Middle Name:KAY
Last Name:IVERSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:9427 SW BARNES RD
Mailing Address - Street 2:STE 599
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225
Mailing Address - Country:US
Mailing Address - Phone:503-292-9099
Mailing Address - Fax:503-384-0872
Practice Address - Street 1:9427 SW BARNES RD
Practice Address - Street 2:STE 599
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-292-9099
Practice Address - Fax:503-384-0872
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD22431207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine