Elizabeth Ann Mandel, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

201806162NP-PP Issued in OR

Practice address

3101 SW Sam Jackson Park Rd
Portland, OR 97239-3095

Phone

(503) 221-3434

Fax

(503) 221-3490

NPI assigned

Apr 17, 2019

Last updated

Apr 17, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Elizabeth Pasternack Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shriners Hospitals for Children

  • Pediatric Orthopaedic Surgery Physician
  • Shreveport, LA
  • NPI 1568803732
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1555459200000",
    "number": "1245893007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 NW 12TH AVE APT 212",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972093067",
            "telephone_number": "860-670-0345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 SW SAM JACKSON PARK RD",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972393095",
            "telephone_number": "503-221-3434",
            "fax_number": "503-221-3490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANDEL",
        "first_name": "ELIZABETH",
        "middle_name": "ANN",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-17",
        "last_updated": "2019-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "OR",
            "license": "201806162NP-PP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "PASTERNACK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Victor R Mancuso, D.D.S., M.S.
• Mandala Acupuncture & Bodywork. LLC
• Mandala Medicine Acupuncture LLC
• Mandala Mental and Behavioral Health, LLC
• David Mandala
• Samantha Allison Mandel, LPC
• Stephanie Mandel, PSY.D.
• Debra Lee Mandelblatt, PA
• Steven J Mandelblatt, M.D.
• Barbara Deborah Mandell, MSW, LCSW

• Pediatric Nurse Practitioner in Portland, OR
• Providers in Portland, OR by specialty
• Pediatric Nurse Practitioner in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.