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General NPI Number Information
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NPI Number | 1346783917
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Entity Type | Individual
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Provider Name | MICHELLE FORD RN
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Gender | Female
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 1006 NE 3RD AVE
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City | CAMAS
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State | WA
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Zip | 98607-1640
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Country | US
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Telephone | 503-348-2410
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Fax |
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Provider Business Mailing Address
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Address Line | 3307 EVERGREEN WAY SUITE 707 # 174
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City | WASHOUGAL
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State | WA
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Zip | 98671-2062
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Country | US
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Telephone | 503-348-2410
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 201506822RN
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License Number State | OR
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