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General NPI Number Information
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NPI Number | 1366061798
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Entity Type | Organization
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Legal Business Name | FLOURISH INTEGRATIVE MEDICINE
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Dates
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Enumeration Date | 04/15/2020
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Last Update Date | 04/15/2020
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Provider Practice Location Address
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Address Line | 2505 SW SPRING GARDEN ST STE 200
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City | PORTLAND
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State | OR
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Zip | 97219-3966
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Country | US
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Telephone | 503-432-8050
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Fax | 503-432-8025
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Provider Business Mailing Address
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Address Line | 2505 SW SPRING GARDEN ST STE 200
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City | PORTLAND
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State | OR
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Zip | 97219-3966
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Country | US
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Telephone | 503-432-8050
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Fax | 503-432-8025
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Authorized Official
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Title or Position | MEMBER
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Name | JENNIFER G OWEN
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Credential | APRN
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Telephone | 503-432-8050
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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