GLENDA A PETERSON (NPI# 1871516773) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871516773 |
| Entity Type | Individual |
| Full Name | GLENDA A PETERSON |
| Credential | PMHN |
| Practice Address |
16110 Sw Regatta Ln Beaverton OR 97006-8942 |
| Mailing Address |
Po Box 42510 Portland OR 97242-0510 |
| Practice Telephone | 5036292131 |
| Practice Fax Number | 5036179379 |
| Mailing Telephone | 5039631290 |
| Mailing Fax Number | 5032301541 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
079039861N6 | OR | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MANAGED HEALTH | 115218 | 01 |
| Street Address |
16110 SW REGATTA LN |
| City | BEAVERTON |
| State | OR |
| Zip Code | 97006-8942 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326021932 | Lynne Phillips Werbel | Social Worker | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2005-11-29 |
| 1922521525 | Amanda Ann Roberson | Counselor | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2017-07-25 |
| 1811176605 | Marie Valentine Soller | Psychiatry & Neurology | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2007-10-29 |
| 1619023512 | Virginia Rae Rosvold | Social Worker | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2007-01-25 |
| 1184647174 | Ann Johnson Howard | Psychiatry & Neurology | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2006-07-25 |
| 1215950126 | Kathy M Danze | Social Worker | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2006-07-25 |
| 1558384362 | Leslie J Myers | Nurse Practitioner | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2006-07-25 |
| 1356364855 | Marcia Kahn | Psychiatry & Neurology | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2006-07-25 |
| 1780606152 | Stuart A Levy | Social Worker | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2006-07-24 |
| 1801817507 | Howard Scott Rosenbaum | Psychiatry & Neurology | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2006-07-21 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184238727 | Hayden Alexander Meriwether | Dentist | 17895 Ne Evergreen Pkwy, #100, Beaverton, OR 97006 | 2020-09-01 |
| 1336781202 | Courtney Rae Murata | Behavior Technician | 337 Nw 215th Terrace, Apt, 106, Hillsboro, OR 97006 | 2019-10-11 |
| 1992355986 | Pamela J. Viado | Technician | 1220 Nw Weybridge Way, Beaverton, OR 97006 | 2019-09-12 |
| 1477115384 | One Change Group | Community/Behavioral Health | 2499 Nw 206th Ave, Apt A233, Hillsboro, OR 97006 | 2019-07-01 |
| 1649731332 | Regina C. Rizo | Social Worker | 1925 Amberglen Parkway, #3a-131, Hillsboro, OR 97006 | 2019-03-26 |
| 1043731912 | Elizabeth A Cintron | Occupational Therapy Assistant | 1189 Ne 89th Ave Apt 305, Hillsboro, OR 97006 | 2017-06-30 |
| 1265979173 | Lindsay Jensen | Massage Therapist | 15220 Nw Greenbrier Pkwy Ste 260, Beaverton, OR 97006 | 2017-01-30 |
| 1851835722 | Changepoint, Inc | Clinic/Center | 1700 Nw 167th Place, Suite 240, Beaverton, OR 97006 | 2016-12-13 |
| 1689126302 | Occupational Health Centers of The Southwest, P.a. (tx) | Clinic/Center | 2225 Nw Towncenter Drive, Beaverton, OR 97006 | 2016-10-28 |
| 1558717413 | Dillon Duvall | Physical Therapist | 16895 Nw Cornell Rd, #110, Beaverton, OR 97006 | 2016-05-10 |
| Find all providers in zip 97006 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851603476 | Michelle Hardenbrook | Nurse Practitioner | 4800 Sw Griffith Dr Ste 104, Beaverton, OR 97005-8700 | 2010-07-12 |
| 1033379235 | Sherry Diane Davidson | Nurse Practitioner | 10700 Sw Beaverton-hillsdale Hwy, Park Plaza West Bld 3 Suite 547, Beaverton, OR 97005 | 2008-06-11 |
| 1720292915 | Raymond Anthony Pienczykowski Jr. | Nurse Practitioner | 1975 Nw 167th Pl, 6, Beaverton, OR 97006-4908 | 2007-05-09 |
| 1891800108 | Marianne Kandel | Nurse Practitioner | 3811-b Sw Hall Blvd, Beaverton, OR 97005-2041 | 2006-08-20 |
| 1124680699 | Mah Psychiatric Services, Inc. | Nurse Practitioner | 4800 Sw Griffith Dr Ste 104, Beaverton, OR 97005-8700 | 2019-07-03 |
| 1396872032 | Heidi Louise Hart | Nurse Practitioner | 15455 Nw Greenbrier Pkwy, Suite 240, Beaverton, OR 97006-7374 | 2007-02-28 |
| 1245379650 | Christine Lynn Mccambridge | Nurse Practitioner | 9700 Sw Beaverton Hillsdale Hwy, Beaverton, OR 97005-3306 | 2007-02-05 |
| 1306947726 | Yoonhui Choe | Nurse Practitioner | 14255 Sw Brigadoon Ct, Beaverton, OR 97005-3369 | 2006-09-26 |
| 1881791515 | Linda G Krentz | Nurse Practitioner | 4855 Sw Western Ave, Beaverton, OR 97005-3460 | 2006-09-17 |
| 1558384362 | Leslie J Myers | Nurse Practitioner | 16110 Sw Regatta Ln, Beaverton, OR 97006-8942 | 2006-07-25 |
| Find all providers in BEAVERTON | ||||
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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.