Organization
OREGON CITY MEDICAL NW, INC
Active
Other names
Tualatin Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DANIELLE BLACKWELL FNP (FNP/OWNER)
(503) 656-9030
Entity
Organization
Contact information
Practice address
6464 SW BORLAND ROAD #D-4, TUALATIN, OR 97062
(503) 487-3001
Mailing address
6464 SW BORLAND ROAD #D-4, TUALATIN, OR 97062
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1500005833
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
218463
—
OR
01
—
R142037
PTAN
OR
Enumeration date
04/29/2015
Last updated
04/29/2015
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