Provider Demographics
NPI:1801502612
Name:HART, ISABEL AVIDAN (CHW)
Entity type:Individual
Prefix:
First Name:ISABEL
Middle Name:AVIDAN
Last Name:HART
Suffix:
Gender:F
Credentials:CHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 NW 9TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3519
Mailing Address - Country:US
Mailing Address - Phone:503-525-0090
Mailing Address - Fax:971-244-0219
Practice Address - Street 1:721 NW 9TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3519
Practice Address - Country:US
Practice Address - Phone:503-525-0090
Practice Address - Fax:971-244-0219
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000108194172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker