Healthcare Provider Details

I. General information

NPI: 1811968985
Provider Name (Legal Business Name): WENDY NOREEN ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 02/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17175 SW TUALATIN VALLEY HWY SUITE B-2
BEAVERTON OR
97006-4584
US

IV. Provider business mailing address

315 SW 5TH AVE SUITE 900
PORTLAND OR
97204-1753
US

V. Phone/Fax

Practice location:
  • Phone: 503-848-5861
  • Fax: 503-848-5863
Mailing address:
  • Phone: 503-416-4100
  • Fax: 503-416-3720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number091000506N3
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: