Healthcare Provider Details

I. General information

NPI: 1861481285
Provider Name (Legal Business Name): NORA LOU FAIRLEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10373 NE HANCOCK ST SUITE 115
PORTLAND OR
97220-3873
US

IV. Provider business mailing address

3439 NE SANDY BLVD PMB 375
PORTLAND OR
97232-1959
US

V. Phone/Fax

Practice location:
  • Phone: 503-235-2833
  • Fax: 503-853-8636
Mailing address:
  • Phone: 503-284-8841
  • Fax: 503-282-3302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD08834
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: