Healthcare Provider Details

I. General information

NPI: 1942882618
Provider Name (Legal Business Name): DELISA JE'ANNE HAMNESS RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13007 NE GLISAN ST
PORTLAND OR
97230-2545
US

IV. Provider business mailing address

13937 SE EASTRIDGE ST
PORTLAND OR
97236-6631
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-7844
  • Fax:
Mailing address:
  • Phone: 503-943-9185
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number098000271RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: