Healthcare Provider Details

I. General information

NPI: 1942205547
Provider Name (Legal Business Name): VALERIE LYNN CECIL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 02/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3930 SE DIVISION ST
PORTLAND OR
97202-1643
US

IV. Provider business mailing address

15300 SE GLADSTONE ST
PORTLAND OR
97236-2483
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-3900
  • Fax:
Mailing address:
  • Phone: 503-761-0212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200250071NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: