Provider Demographics
NPI:1710173190
Name:FIRST AVENUE CLINIC
Entity Type:Organization
Organization Name:FIRST AVENUE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NATUROPATHIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANN
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:FREASE
Authorized Official - Suffix:
Authorized Official - Credentials:ND
Authorized Official - Phone:503-266-2000
Mailing Address - Street 1:322 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:CANBY
Mailing Address - State:OR
Mailing Address - Zip Code:97013-3533
Mailing Address - Country:US
Mailing Address - Phone:503-266-2000
Mailing Address - Fax:503-266-2015
Practice Address - Street 1:322 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3533
Practice Address - Country:US
Practice Address - Phone:503-266-2000
Practice Address - Fax:503-266-2015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1420261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty