Provider Demographics
NPI:1013161405
Name:GOHMAN, LORRAINE WALBURGA (PA-C)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:WALBURGA
Last Name:GOHMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LORRAINE
Other - Middle Name:WALBURGA
Other - Last Name:HOPPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2686
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:9155 SW BARNES RD STE 440
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6631
Practice Address - Country:US
Practice Address - Phone:503-935-8500
Practice Address - Fax:503-935-8505
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA01429363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500605826Medicaid
WA2090873Medicaid