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General NPI Number Information
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NPI Number | 1093573818
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Entity Type | Individual
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Provider Name | BRYN E DAVIES PNP
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Gender | Female
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 1001 N PROVIDENCE DR
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City | NEWBERG
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State | OR
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Zip | 97132-7485
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Country | US
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Telephone | 503-537-1555
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Fax |
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Provider Business Mailing Address
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Address Line | 5133 SW SHATTUCK RD
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City | PORTLAND
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State | OR
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Zip | 97221-1800
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Country | US
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Telephone | 541-598-5492
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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 | 163WP0200X
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Taxonomy Name | Pediatric Registered Nurse
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License Number | 201403609RN
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 10024047
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License Number State | OR
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