Healthcare Provider Details

I. General information

NPI: 1922367044
Provider Name (Legal Business Name): DAVID J KLARBERG FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2012
Last Update Date: 10/28/2021
Certification Date: 10/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 SE 91ST AVE STE 400
HAPPY VALLEY OR
97086-3762
US

IV. Provider business mailing address

9300 SE 91ST AVE STE 400
HAPPY VALLEY OR
97086-3762
US

V. Phone/Fax

Practice location:
  • Phone: 503-775-6500
  • Fax: 503-775-2275
Mailing address:
  • Phone: 832-548-5076
  • Fax: 503-775-2275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20180868NP-PP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number816544
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: