Provider Demographics
NPI:1821123027
Name:FAKHER, AZITA (FNP)
Entity Type:Individual
Prefix:
First Name:AZITA
Middle Name:
Last Name:FAKHER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 MORNINGVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8845
Mailing Address - Country:US
Mailing Address - Phone:503-675-7835
Mailing Address - Fax:
Practice Address - Street 1:2460 NE GRIFFIN OAKS ST
Practice Address - Street 2:SUITE D-1000
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-2672
Practice Address - Country:US
Practice Address - Phone:503-352-0700
Practice Address - Fax:503-352-0705
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR094006745N1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORS93329Medicare UPIN