Theresa M Rardin, PA
Physician Assistant in Gresham, OR. Individual provider (NPI-1).
NPI number1013441997
StatusActive
Last updated in NPPESApr 17, 2017
Details
- NPI
- 1013441997
- Entity type
- Individual (NPI-1)
- Name
- Theresa M Rardin
- Credential
- PA
- Sex
- Female
- Sole proprietor
- Yes
- Enumeration date
- Apr 17, 2017
- Last updated
- Apr 17, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363A00000X | Physician Assistant | PA182032 | OR | Yes |
Practice location
24900 Se Stark St Ste 208Gresham, OR 97030-3382
Phone 503-666-8149
Mailing address
4432 Ne Cesar E Chavez BlvdPortland, OR 97211-8232
Phone 503-867-0019
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