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General NPI Number Information
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NPI Number | 1104697176
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Entity Type | Organization
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Legal Business Name | PNW IV HYDRATION LLC
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 23300 NW BRAVO RD
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City | BUXTON
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State | OR
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Zip | 97109-9401
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Country | US
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Telephone | 916-479-5235
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Fax |
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Provider Business Mailing Address
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Address Line | 23300 NW BRAVO RD
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City | BUXTON
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State | OR
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Zip | 97109-9401
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Country | US
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Telephone | 916-479-5235
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | SANDRA CAROLINE GREENE
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Credential | FNP-C
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Telephone | 916-271-7445
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WI0500X
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Taxonomy Name | Infusion Therapy Registered Nurse
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License Number |
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License Number State |
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