Provider Demographics
NPI:1245287754
Name:SEIDEL-HART, TARYN LISA (NP)
Entity type:Individual
Prefix:
First Name:TARYN
Middle Name:LISA
Last Name:SEIDEL-HART
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TARYN
Other - Middle Name:LISA
Other - Last Name:SEIDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 SE OAK ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-4287
Mailing Address - Country:US
Mailing Address - Phone:503-648-8971
Mailing Address - Fax:503-640-6461
Practice Address - Street 1:900 SE OAK ST STE 201
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4287
Practice Address - Country:US
Practice Address - Phone:503-648-8971
Practice Address - Fax:503-640-6461
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2019-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0950000198RN207P00000X
OR095000198N3363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR025349021OtherBSOR
OR000684Medicaid
OR025349021OtherBSOR
ORP77398Medicare UPIN
OR000684Medicaid
ORP77398001Medicare PIN