Healthcare Provider Details

I. General information

NPI: 1609462340
Provider Name (Legal Business Name): ANDREA MICHELLE CAMERON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1655 SW HIGHLAND AVE STE 3
REDMOND OR
97756-2558
US

IV. Provider business mailing address

1655 SW HIGHLAND AVE STE 3
REDMOND OR
97756-2558
US

V. Phone/Fax

Practice location:
  • Phone: 541-923-2654
  • Fax: 541-548-8099
Mailing address:
  • Phone: 541-923-2654
  • Fax: 541-548-8099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: