=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275611733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ADRIA YVONNE GOODNESS C.N.M., P.M.H.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 07/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 SW WOODS ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97201-4739
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-220-8338
-----------------------------------------------------
Fax | 503-894-9515
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 820211
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97282-1211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 971-220-8338
-----------------------------------------------------
Fax | 503-894-9515
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LX0001X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
-----------------------------------------------------
License Number | 200350075NP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 200350075NP
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------