Active NPI
Tanya R Wormdahl, LMT
- Specialist
- Portland, OR
National Provider Identifier
1255501805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 11215
- Practice address
- 5553 NE Glisan St
300
Portland, OR 97213-3173 - Phone
- (503) 757-3878
- NPI assigned
- Mar 10, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11215 | OR | Primary |
Addresses
Primary practice location
5553 NE Glisan St
300
Portland, OR 97213-3173
Mailing address
5553 NE Glisan St
300
Portland, OR 97213-3173
Phone (503) 757-3878
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11215 | OR | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205107200000",
"number": "1255501805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5553 NE GLISAN ST",
"address_2": "300",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972133173",
"telephone_number": "503-757-3878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5553 NE GLISAN ST",
"address_2": "300",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972133173",
"telephone_number": "503-757-3878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORMDAHL",
"first_name": "TANYA",
"middle_name": "R",
"name_prefix": "Mrs.",
"credential": "LMT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-03-10",
"last_updated": "2008-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OR",
"license": "11215",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.