Healthcare Provider Details

I. General information

NPI: 1790756583
Provider Name (Legal Business Name): REBECCA STORMENT GARCIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA LYNN GARCIA NURSE PRACTITIONER

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK ROAD UHS 8EO
PORTLAND OR
97239
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK ROAD UHS 8EO
PORTLAND OR
97239
US

V. Phone/Fax

Practice location:
  • Phone: 318-281-3432
  • Fax: 318-281-8850
Mailing address:
  • Phone: 503-494-8211
  • Fax: 503-418-6318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPO5881
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP30006572
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number201050149NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: