1912236647 NPI number — MRS. DIANE MORRIS REICH MS, CNC

Table of content: MRS. DIANE MORRIS REICH MS, CNC (NPI 1912236647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912236647 NPI number — MRS. DIANE MORRIS REICH MS, CNC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REICH
Provider First Name:
DIANE
Provider Middle Name:
MORRIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, CNC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912236647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10260 SW GREENBURG RD
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97223-5500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-341-1075
Provider Business Mailing Address Fax Number:
503-293-8499

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10260 SW GREENBURG RD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97223-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-341-1075
Provider Business Practice Location Address Fax Number:
503-293-8499
Provider Enumeration Date:
12/08/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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