Provider Demographics
NPI:1861481285
Name:FAIRLEY, NORA LOU (MD)
Entity Type:Individual
Prefix:DR
First Name:NORA
Middle Name:LOU
Last Name:FAIRLEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3439 NE SANDY BLVD
Mailing Address - Street 2:PMB 375
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1959
Mailing Address - Country:US
Mailing Address - Phone:503-284-8841
Mailing Address - Fax:503-282-3302
Practice Address - Street 1:10373 NE HANCOCK ST
Practice Address - Street 2:SUITE 115
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-3873
Practice Address - Country:US
Practice Address - Phone:503-235-2833
Practice Address - Fax:503-853-8636
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-18
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD088342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR241182Medicaid
OR241182Medicaid
C91710Medicare UPIN