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NPI Code Detail

MEDICARE: POHALA CLINIC PC

MEDICARE: POHALA CLINIC PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175F00000XNaturopathOR
2363LF0000XFamily Nurse Practitioner200150144NPOR

General Provider Information

NPI Number : 1689025231
Entity Type Code : Organization
Provider Name (Legal Business Name) : POHALA CLINIC PC
Provider Business Mailing Address
First Line : 7477 SE 52ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-8206
Country : US
Telephone Number : 503-572-4196
Fax Number : 855-420-5847
Provider Business Practice Location Address
First Line : 7477 SE 52ND AVE
Second Line :
City : PORTLAND
State : OR
Zip : 97206-8206
Country : US
Telephone Number : 503-572-4196
Fax Number : 855-420-5847
Authorized Official
Title or Position : OFFICE MANAGER
Name : BECKY R COPENHAGEN
Credential :
Telephone Number : 503-572-4196
Provider Enumeration Date : 06/24/2016
Last Update Date : 05/12/2017

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Directions to “POHALA CLINIC PC ” Practice Location

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