Provider Demographics
NPI:1710569603
Name:TYRRELL, CLAIRE JEANETTE
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:JEANETTE
Last Name:TYRRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29640 SW ENSCHEDE DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97123-9248
Mailing Address - Country:US
Mailing Address - Phone:503-440-7575
Mailing Address - Fax:
Practice Address - Street 1:29640 SW ENSCHEDE DR
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-9248
Practice Address - Country:US
Practice Address - Phone:503-440-7575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200442416RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse