Healthcare Provider Details

I. General information

NPI: 1376180075
Provider Name (Legal Business Name): IRIS A FRANKLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1584 NE 8TH ST STE 101
GRESHAM OR
97030-5746
US

IV. Provider business mailing address

1584 NE 8TH ST STE 101
GRESHAM OR
97030-5746
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-1649
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number19-CRM-226
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: