Healthcare Provider Details

I. General information

NPI: 1699942011
Provider Name (Legal Business Name): BRENDA M FALLER RPA/RA, RT(R)
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 10/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 NE 47TH AVE SUITE 215
PORTLAND OR
97213-2238
US

IV. Provider business mailing address

545 NE 47TH AVE SUITE 215
PORTLAND OR
97213-2238
US

V. Phone/Fax

Practice location:
  • Phone: 971-344-0499
  • Fax:
Mailing address:
  • Phone: 971-344-0499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License Number106318
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number06 WA 1235
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: