1356504989 NPI number — EMILY YAMASHITA APRN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356504989 NPI number — EMILY YAMASHITA APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YAMASHITA
Provider First Name:
EMILY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEREN
Provider Other First Name:
EMILY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356504989
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 NE 8TH ST STE 300
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALING DEPARTMENT
Provider Business Mailing Address City Name:
GRESHAM
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97030-7318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-988-5155
Provider Business Mailing Address Fax Number:
503-988-3015

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
421 SW OAK ST
Provider Second Line Business Practice Location Address:
210
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97204-1817
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-988-7468
Provider Business Practice Location Address Fax Number:
503-988-3015
Provider Enumeration Date:
07/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  200950133NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 22959 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004236346 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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