Healthcare Provider Details

I. General information

NPI: 1902835275
Provider Name (Legal Business Name): EMILIA CHRISTINA BAZAN-GROW DNP,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13235 SW GLENHAVEN ST
BEAVERTON OR
97005-0958
US

IV. Provider business mailing address

13235 SW GLENHAVEN ST
BEAVERTON OR
97005-0958
US

V. Phone/Fax

Practice location:
  • Phone: 503-750-4937
  • Fax:
Mailing address:
  • Phone: 503-750-4937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN000896
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200850013NP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60048456
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: