MEDICARE: MS. NORI ALEA TREVARTHEN FNP

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	207P00000X	Emergency Medicine Physician	20035010NP-FNP-PP	OR
2	363LF0000X	Family Nurse Practitioner	200350104NP	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	:	1881641397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NORI ALEA TREVARTHEN FNP

Provider Business Mailing Address
First Line	:	PO BOX 3158
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3158
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 NE 99TH AVE
Second Line	:	STE 100
City	:	PORTLAND
State	:	OR
Zip	:	97220-9436
Country	:	US
Telephone Number	:	503-215-9900
Fax Number	:

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	06/01/2012

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