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General NPI Number Information
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NPI Number | 1710173190
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Entity Type | Organization
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Legal Business Name | FIRST AVENUE CLINIC
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 09/19/2007
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Provider Practice Location Address
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Address Line | 322 NW 1ST AVE
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City | CANBY
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State | OR
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Zip | 97013-3533
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Country | US
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Telephone | 503-266-2000
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Fax | 503-266-2015
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Provider Business Mailing Address
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Address Line | 322 NW 1ST AVE
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City | CANBY
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State | OR
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Zip | 97013-3533
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Country | US
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Telephone | 503-266-2000
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Fax | 503-266-2015
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Authorized Official
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Title or Position | NATUROPATHIC PHYSICIAN
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Name | DR. DIANN LYNN FREASE
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Credential | N.D.
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Telephone | 503-266-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 1420
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License Number State | OR
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