Provider Demographics
NPI:1770504763
Name:DUAN, YAN (ARNP)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:
Last Name:DUAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10250 SW GREENBURG RD
Mailing Address - Street 2:4 LINCOLN SUITE 110
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5460
Mailing Address - Country:US
Mailing Address - Phone:503-293-4055
Mailing Address - Fax:503-293-8332
Practice Address - Street 1:10250 SW GREENBURG RD
Practice Address - Street 2:4 LINCOLN SUITE 110
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5443
Practice Address - Country:US
Practice Address - Phone:503-293-4055
Practice Address - Fax:503-293-8332
Is Sole Proprietor?:No
Enumeration Date:2006-07-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA401363L00000X
OR200750041NP FNP-PP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0990014Medicare ID - Type Unspecified
P41870Medicare UPIN