Healthcare Provider Details

I. General information

NPI: 1073802559
Provider Name (Legal Business Name): TERESA BLANSHINE CHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

426 SW STARK ST 3RD FLOOR
PORTLAND OR
97204-2347
US

IV. Provider business mailing address

421 SW OAK ST STE. 210
PORTLAND OR
97204-1817
US

V. Phone/Fax

Practice location:
  • Phone: 503-988-3417
  • Fax: 503-988-3419
Mailing address:
  • Phone: 503-988-3663
  • Fax: 503-988-4098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number201041511RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: