Provider Demographics
NPI:1255363750
Name:RATHBONE, PAMELA J (WHCNP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:J
Last Name:RATHBONE
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 82ND DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:OR
Mailing Address - Zip Code:97027-2550
Mailing Address - Country:US
Mailing Address - Phone:503-905-2526
Mailing Address - Fax:503-974-3256
Practice Address - Street 1:15 82ND DR STE 100
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:OR
Practice Address - Zip Code:97027-2550
Practice Address - Country:US
Practice Address - Phone:503-905-2526
Practice Address - Fax:503-974-3256
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-11-19
Deactivation Date:2024-10-10
Deactivation Code:
Reactivation Date:2024-11-19
Provider Licenses
StateLicense IDTaxonomies
OR092006979RN163WG0000X
OR092006979N7363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR131392Medicare ID - Type UnspecifiedGROUP
ORS60873Medicare UPIN