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General NPI Number Information
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NPI Number | 1235822792
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Entity Type | Individual
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Provider Name | ANUP MAMMEN VARGHESE ARNP
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Gender | Male
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Dates
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Enumeration Date | 05/31/2023
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 9300 SE 91ST AVE STE 400
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City | HAPPY VALLEY
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State | OR
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Zip | 97086-3762
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Country | US
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Telephone | 503-775-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 4267 NW DIAMONDBACK DR
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City | BEAVERTON
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State | OR
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Zip | 97006-7421
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Country | US
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Telephone | 503-329-1568
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 10009021
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License Number State | OR
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