Provider Demographics
NPI:1780740548
Name:BLUMNER, KATE HANNA (MD)
Entity type:Individual
Prefix:
First Name:KATE
Middle Name:HANNA
Last Name:BLUMNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 SE BYBEE BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-5759
Mailing Address - Country:US
Mailing Address - Phone:971-229-0269
Mailing Address - Fax:971-229-0617
Practice Address - Street 1:1600 SE BYBEE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-5759
Practice Address - Country:US
Practice Address - Phone:971-229-0269
Practice Address - Fax:971-229-0617
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1259052084P0800X
PAMD4321292084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500622221Medicaid
OR500626731Medicaid
ORR154062Medicare PIN