Provider Demographics
NPI:1083829089
Name:DREESE, DONALD (CST-CFA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:DREESE
Suffix:
Gender:M
Credentials:CST-CFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3471 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OR
Mailing Address - Zip Code:97032-9621
Mailing Address - Country:US
Mailing Address - Phone:503-318-1862
Mailing Address - Fax:503-207-5370
Practice Address - Street 1:3471 7TH ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OR
Practice Address - Zip Code:97032-9621
Practice Address - Country:US
Practice Address - Phone:503-318-1862
Practice Address - Fax:503-207-5370
Is Sole Proprietor?:No
Enumeration Date:2007-05-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR102653246ZC0007X
OR20064363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant