Healthcare Provider Details

I. General information

NPI: 1245714070
Provider Name (Legal Business Name): AUBREY ANN THAI RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUBREY ANN CRONK

II. Dates (important events)

Enumeration Date: 09/18/2018
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 SW US VETERANS HOSPITAL RD
PORTLAND OR
97239-2964
US

IV. Provider business mailing address

557 SW 197TH PL
BEAVERTON OR
97006-2473
US

V. Phone/Fax

Practice location:
  • Phone: 360-924-1664
  • Fax:
Mailing address:
  • Phone: 360-924-1664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number201804527RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: