Healthcare Provider Details

I. General information

NPI: 1356583660
Provider Name (Legal Business Name): RASHAE PATRICE BURNS CMA, CHW, PBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8939 N FORTUNE AVE UNIT A
PORTLAND OR
97203-2601
US

IV. Provider business mailing address

8939 N FORTUNE AVE UNIT A
PORTLAND OR
97203-2601
US

V. Phone/Fax

Practice location:
  • Phone: 503-957-8098
  • Fax:
Mailing address:
  • Phone: 503-957-8098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number108976
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: