Healthcare Provider Details

I. General information

NPI: 1811600471
Provider Name (Legal Business Name): NORTHWEST IV, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2022
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 NW CORNELL RD STE 190
BEAVERTON OR
97006-8104
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 714-055-9609
  • Fax: 971-405-5961
Mailing address:
  • Phone: 971-358-9292
  • Fax: 503-917-4971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

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