Healthcare Provider Details

I. General information

NPI: 1093573818
Provider Name (Legal Business Name): BRYN E DAVIES PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 10/03/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N PROVIDENCE DR
NEWBERG OR
97132-7485
US

IV. Provider business mailing address

5133 SW SHATTUCK RD
PORTLAND OR
97221-1800
US

V. Phone/Fax

Practice location:
  • Phone: 503-537-1555
  • Fax:
Mailing address:
  • Phone: 541-598-5492
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number201403609RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number10024047
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: