Healthcare Provider Details

I. General information

NPI: 1366388209
Provider Name (Legal Business Name): CORNER HEALTH MEDICAL GROUP NORTHWEST, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10260 SW GREENBURG RD FL 4
PORTLAND OR
97223-5500
US

IV. Provider business mailing address

10260 SW GREENBURG RD FL 4
PORTLAND OR
97223-5500
US

V. Phone/Fax

Practice location:
  • Phone: 425-243-3719
  • Fax:
Mailing address:
  • Phone: 781-738-0037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: ANNE GIFFORD
Title or Position: COO
Credential:
Phone: 781-738-0037