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General NPI Number Information
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NPI Number | 1760628838
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTH CARE LLC
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Dates
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Enumeration Date | 12/19/2008
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Last Update Date | 12/19/2008
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Provider Practice Location Address
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Address Line | 135 SE 102ND AVE
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City | PORTLAND
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State | OR
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Zip | 97216-2703
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Country | US
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Telephone | 503-258-9800
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Fax | 503-258-8311
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Provider Business Mailing Address
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Address Line | 135 SE 102ND AVE
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City | PORTLAND
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State | OR
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Zip | 97216-2703
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Country | US
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Telephone | 503-258-9800
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Fax | 503-258-8311
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MR. STEPHEN ALLRED
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Credential | ARNP
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Telephone | 503-258-9800
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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 | 081047114N3
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License Number State | OR
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