Individual
TIM CHARLES FOULKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
2015 NE 39TH AVE, PORTLAND, OR 97212-5305
(503) 422-3253
(503) 281-0052
Mailing address
2434 NE 36TH AVE, PORTLAND, OR 97212-5241
(503) 284-8372
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
080045508N6
OR
Other
Enumeration date
02/08/2007
Last updated
07/08/2007
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