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General NPI Number Information
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NPI Number | 1013425156
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Entity Type | Individual
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Provider Name | EDITH DONNELLY
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Gender | Female
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Dates
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Enumeration Date | 01/10/2018
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Last Update Date | 01/10/2018
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Provider Practice Location Address
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Address Line | 4115 SE HAGER LN
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City | MILWAUKIE
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State | OR
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Zip | 97267-2925
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Country | US
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Telephone | 716-491-0350
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Fax |
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Provider Business Mailing Address
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Address Line | 25143 S LOMA LINDA DR
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City | BEAVERCREEK
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State | OR
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Zip | 97004-9643
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WG0000X
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Taxonomy Name | General Practice Registered Nurse
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License Number | 200440840RN
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License Number State | OR
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