Healthcare Provider Details

I. General information

NPI: 1790860765
Provider Name (Legal Business Name): LINDA SUE DAMASKOS CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST SUITE 651
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

847 NE 19TH AVE SUITE 300
PORTLAND OR
97232-2684
US

V. Phone/Fax

Practice location:
  • Phone: 503-297-3766
  • Fax: 503-297-8148
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN00057558
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number201041344RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: