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General NPI Number Information
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NPI Number | 1720946569
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Entity Type | Organization
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Legal Business Name | UNDERDOG ALCHEMY
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Dates
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Enumeration Date | 01/12/2026
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Last Update Date | 01/12/2026
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Provider Practice Location Address
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Address Line | 22400 SE STARK ST
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City | GRESHAM
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State | OR
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Zip | 97030-2600
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Country | US
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Telephone | 971-486-6182
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Fax | 971-293-4016
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Provider Business Mailing Address
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Address Line | 22400 SE STARK ST STE 104
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City | GRESHAM
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State | OR
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Zip | 97030-2618
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Country | US
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Telephone | 971-486-6182
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Fax | 971-293-4016
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Authorized Official
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Title or Position | PSYCHIATRIC NURSE PRACTITIONER
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Name | MISHA HARDISON LOVE
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Credential | RN MSN, PMHNP-BC
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Telephone | 971-486-6182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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