Provider Demographics
NPI:1235136615
Name:LOEWER, DEBORAH A (FNP)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:A
Last Name:LOEWER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 SW HALL BLVD
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0504
Mailing Address - Country:US
Mailing Address - Phone:503-644-1171
Mailing Address - Fax:503-914-0335
Practice Address - Street 1:4510 SW HALL BLVD
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0504
Practice Address - Country:US
Practice Address - Phone:503-644-1171
Practice Address - Fax:503-914-0335
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000039204N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000134Medicaid
ORR114198Medicare ID - Type Unspecified
ORS69955Medicare UPIN