Healthcare Provider Details

I. General information

NPI: 1285984294
Provider Name (Legal Business Name): TAMARA MARYLEE PALUMBO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4531 SE BELMONT ST STE 100
PORTLAND OR
97215-1675
US

IV. Provider business mailing address

420 NE MASON ST
PORTLAND OR
97211-3479
US

V. Phone/Fax

Practice location:
  • Phone: 503-546-9429
  • Fax: 503-546-9570
Mailing address:
  • Phone: 503-546-9429
  • Fax: 503-546-9570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number093006963RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: