Healthcare Provider Details

I. General information

NPI: 1528584455
Provider Name (Legal Business Name): CHRISTINA ANN FRANCK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2017
Last Update Date: 02/04/2022
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

15810 SW CARDINAL LOOP
BEAVERTON OR
97007-8493
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-4698
  • Fax:
Mailing address:
  • Phone: 503-753-3594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number201043124RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number201707731CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: