Provider Demographics
NPI:1518649706
Name:COHEN HALVORSON, EMILIE
Entity type:Individual
Prefix:
First Name:EMILIE
Middle Name:
Last Name:COHEN HALVORSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 SW CEDAR HILLS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-1435
Mailing Address - Country:US
Mailing Address - Phone:503-352-6000
Mailing Address - Fax:
Practice Address - Street 1:2725 SW CEDAR HILLS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-1435
Practice Address - Country:US
Practice Address - Phone:503-352-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA221318363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program