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General NPI Number Information
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NPI Number | 1891756961
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Entity Type | Individual
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Provider Name | THERESA A TAYLOR-LIBBY FNP
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Gender | Female
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 3710 SW US VETERANS HOSPITAL RD
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City | PORTLAND
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State | OR
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Zip | 97239-2964
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Country | US
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Telephone | 207-650-5789
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Fax | 503-273-5136
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Provider Business Mailing Address
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Address Line | 3710 SW US VETERANS HOSPITAL RD
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City | PORTLAND
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State | OR
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Zip | 97239-2964
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Country | US
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Telephone | 207-650-5789
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Fax | 503-273-5136
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 201603511NP-PP
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License Number State | OR
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