Healthcare Provider Details

I. General information

NPI: 1376939355
Provider Name (Legal Business Name): REBECCA FISHER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2015
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7668 SW MOHAWK ST
TUALATIN OR
97062-8119
US

IV. Provider business mailing address

PO BOX 2960
TUALATIN OR
97062-2960
US

V. Phone/Fax

Practice location:
  • Phone: 503-885-5110
  • Fax: 186-635-0131
Mailing address:
  • Phone: 503-885-5110
  • Fax: 186-635-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number075034831RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: