DR. ANDREA KLUNDER PETERSEN (NPI# 1326306721) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326306721 |
| Entity Type | Individual |
| Full Name | DR. ANDREA KLUNDER PETERSEN |
| Credential | MD |
| Practice Address |
2801 N Gantenbein Ave Ste 2225 Portland OR 97227-1623 |
| Mailing Address |
Po Box 4399 Portland OR 97208-4399 |
| Practice Telephone | (503) 413-4505 |
| Mailing Telephone | 5034133900 |
| Mailing Fax Number | 5034133710 |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2018-11-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207SG0201X |
Medical Genetics Specialization: Clinical Genetics (M.D.) |
MD181125 | OR | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | MD181125 | OR | Allopathic & Osteopathic Physicians |
| N | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1 Baylor Plz, Bcm 320, Houston, TX 770303411 | 8328241170 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669083382 | Andrea Nicole Petersen | Registered Nurse | 2410 S Limit Ave, Sedalia, MO 65301-6910 | 2020-08-14 |
| 1093163743 | Andrea Petersen | Social Worker | 103 Caroline Ct, Beaver Dam, WI 53916-1833 | 2016-06-02 |
| 1396209094 | Andrea Petersen | Early Intervention Provider Agency | 7000 Austin St, Forest Hills, NY 11375-1022 | 2019-01-27 |
| 1508344466 | Andrea Margo Petersen | Nurse Practitioner | 1406 6th Ave N, Saint Cloud, MN 56303-1900 | 2018-08-02 |
| 1063854669 | Andrea Rae Petersen | Physician Assistant | 14655 Galaxie Ave, Apple Valley, MN 55124-8575 | 2013-07-24 |
| 1952608358 | Andrea Leigh Petersen | Registered Nurse | 2800 Cleveland Ave N, Roseville, MN 55113-1126 | 2011-02-21 |
| 1669661559 | Andrea R Petersen | Dietitian, Registered | 2600 65th Avenue, Osceola, WI 54020-3024 | 2007-10-17 |
| 1851429211 | Andrea Lynn Petersen | Counselor | 720 Wood St, Eureka, CA 95501-4413 | 2007-02-28 |
| Street Address |
2801 N GANTENBEIN AVE STE 2225 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97227-1623 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992827380 | Carrie Elizabeth Jones | Physical Medicine & Rehabilitation | 2801 N Gantenbein Ave Ste 2225, Legacy Emanuel Pediatric Development and Rehab, Portland, OR 97227-1623 | 2007-04-04 |
| 1457579914 | Gisela Porras Serna | Pediatrics | 2801 N Gantenbein Ave Ste 2225, Portland, OR 97227-1623 | 2007-04-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508466574 | Jessica Michelle Simonetti | Psychologist | Portland Psychotherapy Clinic, Research and Training Ce, 3700 N Williams Ave, Portland, OR 97227 | 2020-10-29 |
| 1447812268 | Maksim Yefimov | Physician Assistant | 2800 N Vancouver Ave Ste 130, Portland, OR 97227 | 2019-07-01 |
| 1851955975 | Erin Marie Staples | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave;, Suite 230, Portland, OR 97227 | 2019-04-24 |
| 1922588508 | Melanie Grace Mix | Physician Assistant | 501 N Graham St Ste 420, Portland, OR 97227 | 2018-08-14 |
| 1730615071 | Mehran Giblin | Student in an Organized Health Care Education/Training Program | 2800 N. Vancouver Ave, Suite 230, Legacy Clinic Emanuel, Portland, OR 97227 | 2017-05-05 |
| 1730623687 | Christina Grace Belter | Optometrist | 300 N Graham St Ste 300, Portland, OR 97227 | 2016-12-12 |
| 1407300205 | Jenna Abernathy | Counselor | 3537 N Williams Ave, Portland, OR 97227 | 2016-08-09 |
| 1215390760 | Tanya Marie Woods | Massage Therapist | 3808 N. Williams Ave., Portland, OR 97227 | 2016-04-01 |
| 1033596853 | Eric Allen Martin | Counselor | 2054 N. Vancouver Ave, Portland, OR 97227 | 2015-04-30 |
| 1285040436 | Berk Neurosurgical LLC | Neurological Surgery | 501 N Graham St Ste 500, Portland, OR 97227 | 2014-07-09 |
| Find all providers in zip 97227 | ||||
| Taxonomy Code | 207SG0201X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Medical Genetics |
| Specialization | Clinical Genetics (M.D.) |
| A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Medical Genetics, 2007. http://www.abmg.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Medical Genetics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720407166 | Kimberly Ann Kripps | Medical Genetics | 3181 Sw Sam Jackson Park Rd, 4502/l103, Portland, OR 97239 | 2014-04-14 |
| 1417191081 | Nicoleta Cristina Voian | Medical Genetics | 4805 Ne Glisan St Ste 6n50, Portland, OR 97213-2933 | 2009-04-28 |
| 1558686394 | Caleb Charles Rogers | Medical Genetics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2010-04-05 |
| 1700025681 | Wojciech Krzysztof Wiszniewski | Medical Genetics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2009-02-17 |
| 1801054531 | Stephanie Esther Dukhovny | Medical Genetics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2008-05-29 |
| 1902012180 | Amy C Yang | Medical Genetics | 707 Sw Gaines St, Portland, OR 97239-2901 | 2007-05-15 |
| 1104976638 | Rosemarie Smith | Medical Genetics | 1577 Congress St, 2nd Floor, Portland, ME 04102-2169 | 2007-01-10 |
| 1730239153 | Wendy E Smith | Medical Genetics | 1577 Congress St, 2nd Floor, Portland, ME 04102-2169 | 2007-01-10 |
| 1023103652 | Jacob Anderson Reiss | Medical Genetics | 3325 N Interstate Ave, Portland, OR 97227-1022 | 2006-10-03 |
| 1912915471 | Robb Edwin Moses | Medical Genetics | 3181 Sw Sam Jackson Park Rd, Portland, OR 97239-3011 | 2006-08-03 |
| Find all providers in PORTLAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.