Healthcare Provider Details

I. General information

NPI: 1730372905
Provider Name (Legal Business Name): JULIANA IFEYINWA OGBEAMA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 MOLALLA AVE STE A&B
OREGON CITY OR
97045-2799
US

IV. Provider business mailing address

2730 SE 119TH AVE
PORTLAND OR
97266-1016
US

V. Phone/Fax

Practice location:
  • Phone: 503-656-9030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200850173NP FNP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: