Provider Information for 1528122553
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NORA CHURCH MA
Sex: Female
NPI: 1528122553
Last Updated: 2007-10-29
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1528122553 | ||||||||
| Enumeration Date | 2006-12-21 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 421 SW OAK ST SUITE 520 PORTLAND, OR 97204-1817 United States Phone: 503-988-5464 | Fax: | ||||||||
| Primary Practice Address | 421 SW OAK ST SUITE 520 PORTLAND, OR 97204-1817 United States Phone: 503-988-3999 | Fax: | ||||||||
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