1043287204 NPI number — MRS. PATRICIA KREINBERG VROOMAN CPNP

Table of content: MRS. PATRICIA KREINBERG VROOMAN CPNP (NPI 1043287204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043287204 NPI number — MRS. PATRICIA KREINBERG VROOMAN CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VROOMAN
Provider First Name:
PATRICIA
Provider Middle Name:
KREINBERG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KREINBERG
Provider Other First Name:
PATRICIA
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1043287204
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 N GRAHAM ST
Provider Second Line Business Mailing Address:
SUITE 355
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97227-1654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-413-2560
Provider Business Mailing Address Fax Number:
503-413-2510

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 N GRAHAM ST
Provider Second Line Business Practice Location Address:
SUITE 355
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97227-1654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-2560
Provider Business Practice Location Address Fax Number:
503-413-2510
Provider Enumeration Date:
03/07/2006

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: 363LP0200X , with the licence number:  200150126NP PNP-PP , 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: 268719 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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