Provider Demographics
NPI:1336255587
Name:MANN, EDWARD R (FNP)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:R
Last Name:MANN
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NE MULTNOMAH ST.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2099
Mailing Address - Country:US
Mailing Address - Phone:503-813-4406
Mailing Address - Fax:503-813-2824
Practice Address - Street 1:3550 N. INTERSTATE AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1097
Practice Address - Country:US
Practice Address - Phone:503-285-9321
Practice Address - Fax:503-331-6446
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR088006831N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily