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General NPI Number Information
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NPI Number | 1831802776
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Entity Type | Organization
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Legal Business Name | NW MEDICAL WEIGHT MANAGEMENT LLC
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Dates
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Enumeration Date | 01/05/2023
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Last Update Date | 01/05/2023
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Provider Practice Location Address
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Address Line | 3675 RIVER RD N STE 103
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City | KEIZER
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State | OR
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Zip | 97303-5994
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Country | US
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Telephone | 503-510-0630
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Fax |
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Provider Business Mailing Address
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Address Line | 535 CASTLE GLEN LN N
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City | KEIZER
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State | OR
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Zip | 97303-7497
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Country | US
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Telephone | 503-510-0630
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | AMY PURKEY
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Credential | FNP
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Telephone | 503-510-0630
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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 |
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License Number State |
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