Healthcare Provider Details

I. General information

NPI: 1205155660
Provider Name (Legal Business Name): ROCHELLE RENEE ROCHESTER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROCHELLE RENEE CARTER NP

II. Dates (important events)

Enumeration Date: 05/25/2010
Last Update Date: 06/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870 SW CEDAR HILLS BLVD
BEAVERTON OR
97005-1354
US

IV. Provider business mailing address

1047 SE TAMORA AVE
HILLSBORO OR
97123-4753
US

V. Phone/Fax

Practice location:
  • Phone: 503-646-9222
  • Fax:
Mailing address:
  • Phone: 650-703-4338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number19817
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201394154NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: