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General NPI Number Information
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NPI Number | 1447191333
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Entity Type | Organization
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Legal Business Name | ARBOR VITAE WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 04/03/2026
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Last Update Date | 04/03/2026
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Provider Practice Location Address
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Address Line | 6825 SW SANDBURG ST
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City | TIGARD
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State | OR
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Zip | 97223-8192
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Country | US
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Telephone | 503-208-6254
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Fax | 503-386-3241
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Provider Business Mailing Address
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Address Line | 6825 SW SANDBURG ST
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City | TIGARD
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State | OR
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Zip | 97223-8192
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Country | US
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Telephone | 503-208-6254
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Fax | 503-386-3241
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | JOEL EDWARD STORTRO
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Credential | FNP-C, APRN-NP
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Telephone | 503-208-6254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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