Provider Demographics
NPI:1306469440
Name:MATHISEN, ANNA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:MATHISEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4368 SE OAKHURST ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-9210
Mailing Address - Country:US
Mailing Address - Phone:503-475-3140
Mailing Address - Fax:
Practice Address - Street 1:512 MAIN ST E
Practice Address - Street 2:
Practice Address - City:MONMOUTH
Practice Address - State:OR
Practice Address - Zip Code:97361-2369
Practice Address - Country:US
Practice Address - Phone:503-838-1182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-23
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant