Healthcare Provider Details

I. General information

NPI: 1740859297
Provider Name (Legal Business Name): DANIELA FAWCETT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELA FAWCETT FNP-C

II. Dates (important events)

Enumeration Date: 06/20/2021
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 MEADOWS RD STE 200
LAKE OSWEGO OR
97035-0086
US

IV. Provider business mailing address

15352 SE ARROWHEAD PL
HAPPY VALLEY OR
97086-7379
US

V. Phone/Fax

Practice location:
  • Phone: 855-255-1750
  • Fax: 855-255-0905
Mailing address:
  • Phone: 310-384-6520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10019434
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95017430
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61522042
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: