Provider Demographics
NPI:1306182225
Name:OBERDING, TONI LYNN
Entity type:Individual
Prefix:MISS
First Name:TONI
Middle Name:LYNN
Last Name:OBERDING
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 1:5327 NE COLUMBIA BLVD
Mailing Address - Street 2:#A
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97218-1247
Mailing Address - Country:US
Mailing Address - Phone:503-310-0599
Mailing Address - Fax:
Practice Address - Street 1:5327 NE COLUMBIA BLVD
Practice Address - Street 2:#A
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97218-1247
Practice Address - Country:US
Practice Address - Phone:503-310-0599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-20
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA373112B174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR17OtherKAISER PERMANENTE