Healthcare Provider Details

I. General information

NPI: 1093747537
Provider Name (Legal Business Name): JUANITA GARNOW CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 SW BORLAND RD SUITE A3
TUALATIN OR
97062-8876
US

IV. Provider business mailing address

1830 BLANKENSHIP RD SUITE 200
WEST LINN OR
97068-4181
US

V. Phone/Fax

Practice location:
  • Phone: 971-404-3366
  • Fax: 971-404-3377
Mailing address:
  • Phone: 503-655-3851
  • Fax: 503-655-3318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number081047119RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number081047119CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: