Provider Demographics
NPI:1619969771
Name:PANGBORN, TAWNA RENEE (FNP)
Entity type:Individual
Prefix:
First Name:TAWNA
Middle Name:RENEE
Last Name:PANGBORN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TAWNA
Other - Middle Name:RENEE
Other - Last Name:ADAMS-PANGBORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:19250 SW 90TH AVE
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7585
Practice Address - Country:US
Practice Address - Phone:503-692-3750
Practice Address - Fax:503-691-2324
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450062NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1060461Medicaid
OR213419Medicaid
ORR141386Medicare PIN
ORQ47208Medicare UPIN
WAG8894762Medicare PIN