Healthcare Provider Details

I. General information

NPI: 1831873074
Provider Name (Legal Business Name): AMBER DAWN DEYO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2023
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 NE DIVISION ST
GRESHAM OR
97030-4617
US

IV. Provider business mailing address

4101 NE DIVISION ST
GRESHAM OR
97030-4617
US

V. Phone/Fax

Practice location:
  • Phone: 503-666-3808
  • Fax:
Mailing address:
  • Phone: 503-666-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: