Provider Demographics
NPI:1386300739
Name:RASMUSSEN, TAMARA L (PMHNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:RASMUSSEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:L
Other - Last Name:DIVINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:5228 NE HOYT ST STE 300
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-3055
Practice Address - Country:US
Practice Address - Phone:503-215-4860
Practice Address - Fax:971-282-0138
Is Sole Proprietor?:No
Enumeration Date:2021-11-10
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202200877NP-PP363LP0808X
WAAP61217138363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health