Healthcare Provider Details

I. General information

NPI: 1659694602
Provider Name (Legal Business Name): EMILY DUFFY KRUG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 SE 112TH AVE
PORTLAND OR
97266-2210
US

IV. Provider business mailing address

4033 SE 112TH AVE
PORTLAND OR
97266-2210
US

V. Phone/Fax

Practice location:
  • Phone: 503-278-2668
  • Fax:
Mailing address:
  • Phone: 503-278-2668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number201604363RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: