Healthcare Provider Details

I. General information

NPI: 1538023759
Provider Name (Legal Business Name): JANICE BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2025
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13895 SE 152ND DR
CLACKAMAS OR
97015-5372
US

IV. Provider business mailing address

12400 SE FREEMAN WAY
MILWAUKIE OR
97222-4611
US

V. Phone/Fax

Practice location:
  • Phone: 503-353-5540
  • Fax:
Mailing address:
  • Phone: 503-353-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200941272RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: