1457564817 NPI number — MS. ORAWAN LAOCHUMNANVANIT PMHNP

Table of content: MS. ORAWAN LAOCHUMNANVANIT PMHNP (NPI 1457564817)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457564817 NPI number — MS. ORAWAN LAOCHUMNANVANIT PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAOCHUMNANVANIT
Provider First Name:
ORAWAN
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457564817
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3939 NE HANCOCK STREET
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97212-2933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-545-6465
Provider Business Mailing Address Fax Number:
503-287-4940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3939 NE HANCOCK ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97212-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-545-6465
Provider Business Practice Location Address Fax Number:
503-287-4940
Provider Enumeration Date:
05/08/2007

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: 363LP0808X , with the licence number:  AP30007896 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 20075004NP PMHNP 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: 9656067 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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