Healthcare Provider Details

I. General information

NPI: 1740066950
Provider Name (Legal Business Name): REPERIO HEALTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 10/30/2023
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4784 SE 17TH AVE STE 120
PORTLAND OR
97202-4715
US

IV. Provider business mailing address

4784 SE 17TH AVE STE 120
PORTLAND OR
97202-4715
US

V. Phone/Fax

Practice location:
  • Phone: 844-504-0402
  • Fax: 503-296-5806
Mailing address:
  • Phone: 844-504-0402
  • Fax: 503-296-5806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. TRAVIS BENJAMIN RUSH
Title or Position: CEO
Credential:
Phone: 503-522-8024