Provider Demographics
NPI:1194343640
Name:GEYEN, EMILY ANN (PA-C)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:GEYEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15755 SW SEQUOIA PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-7166
Mailing Address - Country:US
Mailing Address - Phone:503-639-6002
Mailing Address - Fax:
Practice Address - Street 1:15755 SW SEQUOIA PKWY STE 200
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7166
Practice Address - Country:US
Practice Address - Phone:503-639-6002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant