Healthcare Provider Details

I. General information

NPI: 1982525226
Provider Name (Legal Business Name): DAWNBREAKER HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 SE KANE AVE
GRESHAM OR
97080-7349
US

IV. Provider business mailing address

2906 SE KANE AVE
GRESHAM OR
97080-7349
US

V. Phone/Fax

Practice location:
  • Phone: 503-664-7007
  • Fax:
Mailing address:
  • Phone: 503-664-7007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ANDREW HOLDEN
Title or Position: EXECUTIVE DIRECTOR
Credential: FNP, DNP
Phone: 215-397-8509