Provider Demographics
NPI:1215346929
Name:BUCCIANTINI, KATHERINE (AGPCNP, ANP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BUCCIANTINI
Suffix:
Gender:F
Credentials:AGPCNP, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12670 NW BARNES RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-9001
Mailing Address - Country:US
Mailing Address - Phone:503-648-9565
Mailing Address - Fax:
Practice Address - Street 1:12670 NW BARNES RD STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-9001
Practice Address - Country:US
Practice Address - Phone:503-648-9565
Practice Address - Fax:503-648-1282
Is Sole Proprietor?:No
Enumeration Date:2014-08-06
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201402157NP-PP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health