Healthcare Provider Details

I. General information

NPI: 1770613036
Provider Name (Legal Business Name): GEORGE FOX UNIVERSITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MERIDIAN ST
NEWBERG OR
97132-2697
US

IV. Provider business mailing address

1822 NW SAINT ANDREWS DR
MCMINNVILLE OR
97128-2430
US

V. Phone/Fax

Practice location:
  • Phone: 503-554-2912
  • Fax: 503-554-3864
Mailing address:
  • Phone: 503-472-6620
  • Fax: 503-554-3864

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT-AT-334390
License Number StateOR

VIII. Authorized Official

Name: MS. LISA BURTON
Title or Position: DIRECTOR HUMAN RESOURCES
Credential:
Phone: 504-554-2183