Healthcare Provider Details

I. General information

NPI: 1205239423
Provider Name (Legal Business Name): LAURIE MUHLBAUER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURIE TEFFT PMHNP

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 11/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 NW BETHANY BLVD STE 320
BEAVERTON OR
97006
US

IV. Provider business mailing address

1500 NW BETHANY BLVD STE 320
BEAVERTON OR
97006
US

V. Phone/Fax

Practice location:
  • Phone: 503-567-3260
  • Fax: 503-567-3264
Mailing address:
  • Phone: 503-567-3260
  • Fax: 503-567-3264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number201406457RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201406458NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: