Healthcare Provider Details

I. General information

NPI: 1265674022
Provider Name (Legal Business Name): DENISON CLINICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22115 NW IMBRIE DR SUITE 120
HILLSBORO OR
97124-6988
US

IV. Provider business mailing address

22115 NW IMBRIE DR SUITE 120
HILLSBORO OR
97124-6988
US

V. Phone/Fax

Practice location:
  • Phone: 503-647-7522
  • Fax: 503-647-7522
Mailing address:
  • Phone: 503-647-7522
  • Fax: 503-647-7522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY DENISON
Title or Position: OWNER/MEMBER
Credential: MS, ANP
Phone: 503-647-7522