Katherine Felicia Edstrom
Nurse Practitioner - Gerontology
3181 Sw Sam Jackson Park Rd
Portland
, Oregon 97239-3011
Katherine Felicia Edstrom
Nurse Practitioner - Gerontology
3181 Sw Sam Jackson Park Rd
Portland
, Oregon 97239-3011
(503) 418-5505
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About
Features
Specialties
- Nurse Practitioner - Gerontology
Languages spoken
- English
Location
First Address
- Katherine Felicia Edstrom
- 3181 Sw Sam Jackson Park Rd
- Portland, OR
- Zip : 97239-3011
- Fax : (503) 418-5505
- Phone : (503) 494-8562
Second Address
- Katherine Felicia Edstrom
- 3181 Sw Sam Jackson Park Rd
- Portland, OR
- Zip : 97239-3011
- Fax : (503) 418-5505
- Phone : (503) 494-8562
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LG0600X | Nurse Practitioner - Gerontology | 201905490NP-PP | OR |
National Provider Identifier
| NPI | 1043862550 |
|---|---|
| Provider Name | Katherine Felicia Edstrom |
| First Address | Portland, OR 97239-3011 |
| Second Address | Portland, OR 97239-3011 |
| Gender | F |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/07/2019 |
| Last Update Date | 17/09/2019 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.