Healthcare Provider Details

I. General information

NPI: 1700103975
Provider Name (Legal Business Name): MS. AUBREY BRIDGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2010
Last Update Date: 02/01/2021
Certification Date: 02/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51377 SW OLD PORTLAND RD
SCAPPOOSE OR
97056-4023
US

IV. Provider business mailing address

51377 SW OLD PORTLAND RD STE C
SCAPPOOSE OR
97056-4023
US

V. Phone/Fax

Practice location:
  • Phone: 503-418-4222
  • Fax:
Mailing address:
  • Phone: 503-418-4222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA156186
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: