Provider Demographics
NPI:1689827032
Name:LAURA NEPVEU, M.D., P.C.
Entity Type:Organization
Organization Name:LAURA NEPVEU, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEPVEU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-692-5300
Mailing Address - Street 1:19250 SW 65TH AVE
Mailing Address - Street 2:SUIT #255
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-7452
Mailing Address - Country:US
Mailing Address - Phone:503-692-5300
Mailing Address - Fax:503-692-5331
Practice Address - Street 1:19250 SW 65TH AVE
Practice Address - Street 2:SUIT #255
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-7452
Practice Address - Country:US
Practice Address - Phone:503-692-5300
Practice Address - Fax:503-692-5331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18304261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR073200Medicaid
OR370014245OtherRAILROAD MEDICARE
OR073200Medicaid
ORR103417Medicare PIN