Healthcare Provider Details

I. General information

NPI: 1750863643
Provider Name (Legal Business Name): NATALIE ROSE REDMOND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2018
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10180 SE SUNNYSIDE RD
CLACKAMAS OR
97015-8970
US

IV. Provider business mailing address

1800 SW 6TH AVE STE 600
PORTLAND OR
97201-5204
US

V. Phone/Fax

Practice location:
  • Phone: 503-571-6401
  • Fax: 503-571-0869
Mailing address:
  • Phone: 503-725-4712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: