Provider Demographics
NPI:1881870327
Name:RICH, ROBERTA MERYL (PA-C)
Entity type:Individual
Prefix:MISS
First Name:ROBERTA
Middle Name:MERYL
Last Name:RICH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MRS
Other - First Name:ROBERTA
Other - Middle Name:MERYL
Other - Last Name:RICH-JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2051 KAEN RD
Mailing Address - Street 2:
Mailing Address - City:OREGON CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97045-4035
Mailing Address - Country:US
Mailing Address - Phone:503-650-3110
Mailing Address - Fax:
Practice Address - Street 1:37400 BELL ST
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-7868
Practice Address - Country:US
Practice Address - Phone:503-668-3483
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-15
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15644363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical