Provider Demographics
NPI:1982962163
Name:YANIT-MITCHUM, KEENAN ELIZABETH (MD)
Entity Type:Individual
Prefix:MRS
First Name:KEENAN
Middle Name:ELIZABETH
Last Name:YANIT-MITCHUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KEENAN
Other - Middle Name:ELIZABETH HOLBROOK
Other - Last Name:YANIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:3181 SW SAM JACKSON PARK ROAD
Mailing Address - Street 2:MAIL CODE UHN 50
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239
Mailing Address - Country:US
Mailing Address - Phone:503-494-9000
Mailing Address - Fax:503-494-3111
Practice Address - Street 1:3181 SW SAM JACKSON PARK ROAD
Practice Address - Street 2:MAIL CODE UHN 50
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-9000
Practice Address - Fax:503-494-3111
Is Sole Proprietor?:No
Enumeration Date:2012-04-25
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD178876207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology