Provider Demographics
NPI:1750834545
Name:NATH, JANE ELIZABETH ADKINS (CNM)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH ADKINS
Last Name:NATH
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:E
Other - Last Name:ADKINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19250 SW 65TH AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7452
Practice Address - Country:US
Practice Address - Phone:503-692-1242
Practice Address - Fax:503-691-3615
Is Sole Proprietor?:No
Enumeration Date:2016-07-27
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201604598NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500711761Medicaid
ORR190936OtherMEDICARE PTAN