Healthcare Provider Details

I. General information

NPI: 1598701419
Provider Name (Legal Business Name): KIMILA DENISE ORTH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26951 SE FORRESTER RD
BORING OR
97009-9114
US

IV. Provider business mailing address

PO BOX 2247
GRESHAM OR
97030-0638
US

V. Phone/Fax

Practice location:
  • Phone: 503-637-3344
  • Fax: 503-637-3378
Mailing address:
  • Phone: 503-519-6038
  • Fax: 503-637-3378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: