Healthcare Provider Details

I. General information

NPI: 1033379235
Provider Name (Legal Business Name): SHERRY DIANE DAVIDSON PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10700 SW BEAVERTON-HILLSDALE HWY PARK PLAZA WEST BLD 3 SUITE 547
BEAVERTON OR
97005
US

IV. Provider business mailing address

10700 SW BEAVERTON-HILLSDALE HWY PARK PLAZA WEST BLD 3 SUITE 547
BEAVERTON OR
97005
US

V. Phone/Fax

Practice location:
  • Phone: 503-643-0428
  • Fax:
Mailing address:
  • Phone: 503-643-0428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number077027292N6PMHNPPP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: