Healthcare Provider Details

I. General information

NPI: 1407283237
Provider Name (Legal Business Name): BRIDGES FAMILY WELLNESS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2013
Last Update Date: 10/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22400 SE STARK ST SUITE 105
GRESHAM OR
97030-2656
US

IV. Provider business mailing address

22400 SE STARK ST SUITE 105
GRESHAM OR
97030-2656
US

V. Phone/Fax

Practice location:
  • Phone: 503-492-1221
  • Fax: 503-907-0098
Mailing address:
  • Phone: 503-492-1221
  • Fax: 503-907-0098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number1975
License Number StateOR

VIII. Authorized Official

Name: DR. DANIELLE QUIMBY CURREY
Title or Position: OWNER
Credential: ND
Phone: 503-492-1221