Provider Demographics
NPI:1811035777
Name:HANAVAN, KATHRYN ANN (RN MSN ANP)
Entity Type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:ANN
Last Name:HANAVAN
Suffix:
Gender:F
Credentials:RN MSN ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:14319 ORCHARD SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-6541
Mailing Address - Country:US
Mailing Address - Phone:503-699-7730
Mailing Address - Fax:
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:OP05DC
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-494-8311
Practice Address - Fax:503-494-4781
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR079044074N3 ANP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP13452Medicare UPIN
OR107999Medicare ID - Type Unspecified