Healthcare Provider Details

I. General information

NPI: 1548511306
Provider Name (Legal Business Name): ANGELA DAWN FREYER MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 FALK RD
VANCOUVER WA
98661-6392
US

IV. Provider business mailing address

315 NE 22ND AVE
PORTLAND OR
97232-2806
US

V. Phone/Fax

Practice location:
  • Phone: 360-313-1000
  • Fax:
Mailing address:
  • Phone: 503-914-9941
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberOT 60104489
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: