Provider Demographics
NPI:1811968985
Name:NOREEN, WENDY (ANP)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:NOREEN
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 SW 5TH AVE
Mailing Address - Street 2:SUITE 900
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97204-1753
Mailing Address - Country:US
Mailing Address - Phone:503-416-4100
Mailing Address - Fax:503-416-3720
Practice Address - Street 1:17175 SW TUALATIN VALLEY HWY
Practice Address - Street 2:SUITE B-2
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-4584
Practice Address - Country:US
Practice Address - Phone:503-848-5861
Practice Address - Fax:503-848-5863
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR091000506N3363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP36924Medicare UPIN
OR110055Medicare ID - Type UnspecifiedMEDICARE NUMBER