Healthcare Provider Details

I. General information

NPI: 1770741852
Provider Name (Legal Business Name): KARLEEN SWARZTRAUBER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 VILLA RD
NEWBERG OR
97132-1833
US

IV. Provider business mailing address

PO BOX 19266
PORTLAND OR
97280-0266
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-4544
  • Fax:
Mailing address:
  • Phone: 503-675-6776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD22724
License Number StateCA

VIII. Authorized Official

Name: KARLEEN SWARZTRAUBER
Title or Position: PHYSICIAN
Credential: MD
Phone: 503-675-6776