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General NPI Number Information
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NPI Number | 1164600243
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Entity Type | Organization
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Legal Business Name | NORTHWEST GYNECOLOGY ASSOCIATES,LLC
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 01/31/2008
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Provider Practice Location Address
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Address Line | 4660 NE BELKNAP CT STE 109
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City | HILLSBORO
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State | OR
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Zip | 97124-8402
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Country | US
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Telephone | 503-352-3854
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Fax | 503-924-2769
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Provider Business Mailing Address
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Address Line | PO BOX 1719
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City | HILLSBORO
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State | OR
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Zip | 97123-1719
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Country | US
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Telephone | 503-352-3854
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Fax | 503-924-2769
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Authorized Official
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Title or Position | OFFICE/BILLING MANAGER
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Name | MS. BRIGETTE KREVANKO
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Credential |
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Telephone | 503-352-3854
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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