Provider Demographics
NPI:1750703450
Name:CHESTERFIELD, EMILEE MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:EMILEE
Middle Name:MARIE
Last Name:CHESTERFIELD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:EMILEE
Other - Middle Name:MARIE
Other - Last Name:LANCASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4727 NE 90TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4717
Mailing Address - Country:US
Mailing Address - Phone:812-603-4435
Mailing Address - Fax:
Practice Address - Street 1:19260 SW 65TH AVE STE 270
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-5705
Practice Address - Country:US
Practice Address - Phone:503-692-9525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-14
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10001545A363AM0700X
363AM0700X
ORPA174070363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical