MEDICARE: DR. NORA LOU FAIRLEY MD

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
1	2084P0800X	Psychiatry Physician	MD08834	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861481285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NORA LOU FAIRLEY MD

Provider Business Mailing Address
First Line	:	3439 NE SANDY BLVD
Second Line	:	PMB 375
City	:	PORTLAND
State	:	OR
Zip	:	97232-1959
Country	:	US
Telephone Number	:	503-284-8841
Fax Number	:	503-282-3302

Provider Business Practice Location Address
First Line	:	10373 NE HANCOCK ST
Second Line	:	SUITE 115
City	:	PORTLAND
State	:	OR
Zip	:	97220-3873
Country	:	US
Telephone Number	:	503-235-2833
Fax Number	:	503-853-8636

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	04/29/2008

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