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General NPI Number Information
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NPI Number | 1689557290
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Entity Type | Organization
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Legal Business Name | AGERIGHT CLINICAL SERVICES WA, PLLC
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Dates
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Enumeration Date | 07/30/2025
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 4560 SE INTERNATIONAL WAY STE 100
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City | MILWAUKIE
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State | OR
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Zip | 97222-4628
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Country | US
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Telephone | 971-206-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 4560 SE INTERNATIONAL WAY STE 100
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City | MILWAUKIE
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State | OR
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Zip | 97222-4628
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CORPORATE CONTROLLER
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Name | STACI TONE
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Credential |
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Telephone | 971-206-5125
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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