Provider Demographics
NPI:1023098068
Name:BRANDON, PATRICIA LEE (WHCNP, FNP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:LEE
Last Name:BRANDON
Suffix:
Gender:F
Credentials:WHCNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1427 NW FLANDERS ST STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-2646
Mailing Address - Country:US
Mailing Address - Phone:503-297-0235
Mailing Address - Fax:150-337-9152
Practice Address - Street 1:1427 NW FLANDERS ST STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-2646
Practice Address - Country:US
Practice Address - Phone:503-297-0235
Practice Address - Fax:150-337-9152
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR33003N1363LF0000X
OR33003N7363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR142614Medicare UPIN