Healthcare Provider Details

I. General information

NPI: 1952384430
Provider Name (Legal Business Name): PAMELA A. DEVISSER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 04/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18040 SW LOWER BOONES FERRY RD SUITE 100
TIGARD OR
97224-7258
US

IV. Provider business mailing address

PO BOX 3158
PORTLAND OR
97208-3158
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-0700
  • Fax: 503-216-0750
Mailing address:
  • Phone: 503-215-6494
  • Fax: 503-215-6644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number88-006444
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: