Provider Demographics
NPI:1043287204
Name:VROOMAN, PATRICIA KREINBERG (CPNP)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:KREINBERG
Last Name:VROOMAN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:MISS
Other - First Name:PATRICIA
Other - Middle Name:DAWN
Other - Last Name:KREINBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:501 N GRAHAM ST
Mailing Address - Street 2:SUITE 355
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1654
Mailing Address - Country:US
Mailing Address - Phone:503-413-2560
Mailing Address - Fax:503-413-2510
Practice Address - Street 1:501 N GRAHAM ST
Practice Address - Street 2:SUITE 355
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1654
Practice Address - Country:US
Practice Address - Phone:503-413-2560
Practice Address - Fax:503-413-2510
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200150126NP PNP-PP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR268719Medicaid