Healthcare Provider Details

I. General information

NPI: 1164600243
Provider Name (Legal Business Name): NORTHWEST GYNECOLOGY ASSOCIATES,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 NE BELKNAP CT STE 109
HILLSBORO OR
97124-8402
US

IV. Provider business mailing address

PO BOX 1719
HILLSBORO OR
97123-1719
US

V. Phone/Fax

Practice location:
  • Phone: 503-352-3854
  • Fax: 503-924-2769
Mailing address:
  • Phone: 503-352-3854
  • Fax: 503-924-2769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. BRIGETTE KREVANKO
Title or Position: OFFICE/BILLING MANAGER
Credential:
Phone: 503-352-3854