Provider Demographics
NPI:1598538241
Name:FANNING, SYDNEY HANNA (PMHNP)
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:HANNA
Last Name:FANNING
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:SYDNEY
Other - Middle Name:HANNA
Other - Last Name:FANNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:11537 SW COLLINA LANE
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070
Mailing Address - Country:US
Mailing Address - Phone:503-860-7812
Mailing Address - Fax:
Practice Address - Street 1:10300 SW EASTRIDGE ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225
Practice Address - Country:US
Practice Address - Phone:503-944-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-03
Last Update Date:2025-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10018078363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health