Provider Demographics
NPI:1457564817
Name:LAOCHUMNANVANIT, ORAWAN (PMHNP)
Entity Type:Individual
Prefix:MS
First Name:ORAWAN
Middle Name:
Last Name:LAOCHUMNANVANIT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 NE HANCOCK STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2933
Mailing Address - Country:US
Mailing Address - Phone:503-545-6465
Mailing Address - Fax:503-287-4940
Practice Address - Street 1:3939 NE HANCOCK ST
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-5321
Practice Address - Country:US
Practice Address - Phone:503-545-6465
Practice Address - Fax:503-287-4940
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30007896363LP0808X
OR20075004NP PMHNP PP363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9656067Medicaid
WA9656067Medicaid