Healthcare Provider Details

I. General information

NPI: 1962828848
Provider Name (Legal Business Name): COLLEEN DUNCAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 E POWELL BLVD
GRESHAM OR
97030-7605
US

IV. Provider business mailing address

1142 SE ROBERTS AVE
GRESHAM OR
97080-7844
US

V. Phone/Fax

Practice location:
  • Phone: 503-667-1500
  • Fax:
Mailing address:
  • Phone: 971-506-7587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number17665
License Number StateOR

VII. Legacy identifiers

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

# 1
Identifier17665
Identifier TypeOTHER
Identifier State
Identifier IssuerLICENSE NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: