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General NPI Number Information
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NPI Number | 1275061681
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Entity Type | Organization
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Legal Business Name | PACIFIC NW FAMILY PRACTICE, LIMITED LIABILITY COMPANY
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Dates
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Enumeration Date | 05/30/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 256 SE 2ND AVE
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City | HILLSBORO
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State | OR
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Zip | 97123-4017
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Country | US
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Telephone | 503-648-1003
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Fax | 503-648-1013
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Provider Business Mailing Address
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Address Line | 256 SE 2ND AVE
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City | HILLSBORO
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State | OR
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Zip | 97123-4017
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Country | US
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Telephone | 503-648-1003
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Fax | 503-648-1013
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Authorized Official
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Title or Position | CERTIFIED PHYSICIAN ASSISTANT
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Name | JANE KATHERINE HOPSON
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Credential | PA-C
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Telephone | 503-648-1003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | PA01299
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01299
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License Number State | OR
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