Healthcare Provider Details

I. General information

NPI: 1407150949
Provider Name (Legal Business Name): DEBRA KAYE WHITE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/24/2010
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19250 SW 65TH AVE SUITE 135
TUALATIN OR
97062-7452
US

IV. Provider business mailing address

847 NE 19TH AVE SUITE 300
PORTLAND OR
97232-2684
US

V. Phone/Fax

Practice location:
  • Phone: 503-692-8560
  • Fax: 503-692-8562
Mailing address:
  • Phone: 503-963-2801
  • Fax: 503-963-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN00147798
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP60156749
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201150017NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: