Provider Demographics
NPI:1922090232
Name:RYDELL, KAREN ANN (RN, ANP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:RYDELL
Suffix:
Gender:F
Credentials:RN, ANP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:
Other - Last Name:RYDELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, ANP
Mailing Address - Street 1:1111 NE 99TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-9442
Mailing Address - Country:US
Mailing Address - Phone:503-962-1000
Mailing Address - Fax:503-962-1005
Practice Address - Street 1:6350 NE HALSEY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-4720
Practice Address - Country:US
Practice Address - Phone:503-215-2669
Practice Address - Fax:503-215-8465
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR086000043N3 ANP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR291783Medicaid
ORR160137Medicare PIN
ORS83897Medicare UPIN
ORR160139Medicare PIN
OR291783Medicaid