Individual
TERESA MARIE FUDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
(503) 228-7134
Mailing address
1318 NW 20TH AVE, SUITE B, PORTLAND, OR 97209-1671
(503) 758-5450
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
OR
163WA0400X
Addiction (Substance Use Disorder) Registered Nurse
—
OR
163WC1500X
Community Health Registered Nurse
—
OR
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
—
OR
Other
Enumeration date
01/30/2007
Last updated
01/18/2008
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