Provider Demographics
NPI:1942525761
Name:PABST, ANTHONY (DNP, PMHNP-BC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:PABST
Suffix:
Gender:M
Credentials:DNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7105 SW VARNS ST STE 270
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8173
Mailing Address - Country:US
Mailing Address - Phone:503-389-1500
Mailing Address - Fax:800-974-5025
Practice Address - Street 1:7105 SW VARNS ST STE 270
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8173
Practice Address - Country:US
Practice Address - Phone:503-389-1500
Practice Address - Fax:800-974-5025
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201150092NP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR163701Medicare UPIN