Healthcare Provider Details

I. General information

NPI: 1053779488
Provider Name (Legal Business Name): FIBROMYALGIA FOCUS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2016
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1675 SW MARLOW AVE SUITE 210B
PORTLAND OR
97225-5104
US

IV. Provider business mailing address

1675 SW MARLOW AVE STE 210B
PORTLAND OR
97225-5162
US

V. Phone/Fax

Practice location:
  • Phone: 503-389-3106
  • Fax: 503-546-4223
Mailing address:
  • Phone: 503-389-3106
  • Fax: 503-546-4223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200150080
License Number StateOR

VIII. Authorized Official

Name: MRS. CHERYL ANN HRYCIW
Title or Position: NURSE PRACTITIONER
Credential: MS, FNP
Phone: 971-344-8600