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General NPI Number Information
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NPI Number | 1265674022
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Entity Type | Organization
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Legal Business Name | DENISON CLINICAL ASSOCIATES
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Dates
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Enumeration Date | 03/25/2009
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Last Update Date | 03/25/2009
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Provider Practice Location Address
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Address Line | 22115 NW IMBRIE DR SUITE 120
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City | HILLSBORO
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State | OR
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Zip | 97124-6988
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Country | US
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Telephone | 503-647-7522
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Fax | 503-647-7522
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Provider Business Mailing Address
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Address Line | 22115 NW IMBRIE DR SUITE 120
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City | HILLSBORO
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State | OR
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Zip | 97124-6988
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Country | US
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Telephone | 503-647-7522
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Fax | 503-647-7522
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Authorized Official
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Title or Position | OWNER/MEMBER
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Name | SHELLEY DENISON
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Credential | MS, ANP
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Telephone | 503-647-7522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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