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General NPI Number Information
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NPI Number | 1710153044
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Entity Type | Organization
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Legal Business Name | COACHESLIBRARY
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 14103 SW WAGONER PL
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City | TIGARD
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State | OR
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Zip | 97224-1796
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Country | US
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Telephone | 503-347-8042
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 23933
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City | TIGARD
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State | OR
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Zip | 97281-3933
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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 | REGISTERED NURSE
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Name | KATHLEEN NAJDEK
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Credential |
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Telephone | 503-347-8042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | 076036037
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License Number State | OR
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