Healthcare Provider Details

I. General information

NPI: 1841627528
Provider Name (Legal Business Name): TAMI L RADFORD FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMI L PEARCE FNP

II. Dates (important events)

Enumeration Date: 09/26/2013
Last Update Date: 09/29/2020
Certification Date: 09/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 NW COUNCIL DR STE 125
GRESHAM OR
97030
US

IV. Provider business mailing address

831 NW COUNCIL DR STE 125
GRESHAM OR
97030-3794
US

V. Phone/Fax

Practice location:
  • Phone: 503-661-3439
  • Fax: 503-669-1360
Mailing address:
  • Phone: 503-661-3439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201805467NP
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: