Healthcare Provider Details

I. General information

NPI: 1568973295
Provider Name (Legal Business Name): TORBARI NGIA GBAANADOR REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 10/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13007 NE GLISAN ST
PORTLAND OR
97230-2545
US

IV. Provider business mailing address

14232 E BURNSIDE ST APT 111
PORTLAND OR
97233-1897
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-7844
  • Fax: 503-215-7864
Mailing address:
  • Phone: 503-515-7307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201608213RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: