Healthcare Provider Details

I. General information

NPI: 1609595297
Provider Name (Legal Business Name): DAUGHTERS OF ASCLEPIUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2022
Last Update Date: 10/05/2023
Certification Date: 09/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17050 PILKINGTON RD STE 220
LAKE OSWEGO OR
97035-6309
US

IV. Provider business mailing address

17050 PILKINGTON RD STE 220
LAKE OSWEGO OR
97035-6309
US

V. Phone/Fax

Practice location:
  • Phone: 564-225-0966
  • Fax: 866-522-6255
Mailing address:
  • Phone: 564-225-0966
  • Fax: 866-522-6255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMIE D COCHRAN
Title or Position: FOUNDER, CEO
Credential: MSN, FNP-C
Phone: 564-225-0966