Healthcare Provider Details

I. General information

NPI: 1073951208
Provider Name (Legal Business Name): BRITTNEY B MENSEN DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 07/17/2020
Certification Date: 07/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 101
GRESHAM OR
97030-3722
US

IV. Provider business mailing address

831 NW COUNCIL DR STE 101
GRESHAM OR
97030-3722
US

V. Phone/Fax

Practice location:
  • Phone: 503-665-8176
  • Fax: 503-665-8178
Mailing address:
  • Phone: 503-665-8176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO198911
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: