Healthcare Provider Details

I. General information

NPI: 1447065636
Provider Name (Legal Business Name): LIFE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2025
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 SW REDWOOD LN STE 150
TIGARD OR
97224-7184
US

IV. Provider business mailing address

6650 SW REDWOOD LN STE 150
TIGARD OR
97224-7184
US

V. Phone/Fax

Practice location:
  • Phone: 503-443-2250
  • Fax:
Mailing address:
  • Phone: 503-443-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DAVID KENNY
Title or Position: ADMINISTRATOR
Credential:
Phone: 503-399-0021