Healthcare Provider Details

I. General information

NPI: 1497761001
Provider Name (Legal Business Name): JOANN S. DEUTSCHE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SW GAINES ST
PORTLAND OR
97239-2901
US

IV. Provider business mailing address

6624 NW MERIDIAN RIDGE DR
PORTLAND OR
97210-6600
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-8716
  • Fax:
Mailing address:
  • Phone: 503-313-4717
  • Fax: 503-494-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number096007681N1
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number096007681RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: