Healthcare Provider Details

I. General information

NPI: 1659644219
Provider Name (Legal Business Name): BLYTHE MARIE HARRISON-SAYRE RN RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6253 NE SACRAMENTO ST
PORTLAND OR
97213-4063
US

IV. Provider business mailing address

6253 NE SACRAMENTO ST
PORTLAND OR
97213-4063
US

V. Phone/Fax

Practice location:
  • Phone: 503-331-1370
  • Fax:
Mailing address:
  • Phone: 503-331-1370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201043224RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2279C0205X
TaxonomyCritical Care Registered Respiratory Therapist
License NumberRT-P-000002
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: