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General NPI Number Information
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NPI Number | 1770331076
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Entity Type | Individual
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Provider Name | NARCY MANEJA FORAKER DNP
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Gender | Female
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Dates
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Enumeration Date | 05/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 3181 SW SAM JACKSON PARK ROAD, OC14HO
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City | PORTLAND
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State | OR
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Zip | 97239
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Country | US
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Telephone | 503-494-5058
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Fax | 503-494-3465
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Provider Business Mailing Address
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Address Line | 1400 SW 5TH AVE STE 500
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City | PORTLAND
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State | OR
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Zip | 97201-5537
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Country | US
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Telephone | 866-617-6855
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Fax | 503-346-8015
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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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 | 10029013
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License Number State | OR
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