Healthcare Provider Details

I. General information

NPI: 1801564141
Provider Name (Legal Business Name): NORTHWEST IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8285 W ARBY AVE STE 200
LAS VEGAS NV
89113-2236
US

IV. Provider business mailing address

6400 SE LAKE RD STE 430
PORTLAND OR
97222-2129
US

V. Phone/Fax

Practice location:
  • Phone: 971-358-9292
  • Fax:
Mailing address:
  • Phone: 971-358-9292
  • Fax: 503-917-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOHN PERRY
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 503-447-3285