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General NPI Number Information
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NPI Number | 1083915508
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Entity Type | Organization
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Legal Business Name | CANBY HEALTHCARE CLINIC LLC
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Dates
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Enumeration Date | 11/15/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 703 SE 1ST AVE
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City | CANBY
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State | OR
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Zip | 97013-3849
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Country | US
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Telephone | 503-266-7686
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Fax | 503-266-7382
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Provider Business Mailing Address
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Address Line | 18320 S WALKER RD
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City | OREGON CITY
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State | OR
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Zip | 97045-9326
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Country | US
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Telephone | 503-631-3420
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Fax |
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Authorized Official
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Title or Position | STAFF ADULT NURSE PRACTITIONER
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Name | KAREN ELIZABETH SHAW
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Credential | ANP
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Telephone | 503-266-7686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 085074804
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License Number State | OR
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