Provider Demographics
NPI:1902835275
Name:BAZAN-GROW, EMILIA CHRISTINA (DNP,FNP)
Entity Type:Individual
Prefix:DR
First Name:EMILIA
Middle Name:CHRISTINA
Last Name:BAZAN-GROW
Suffix:
Gender:F
Credentials:DNP,FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13235 SW GLENHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-0958
Mailing Address - Country:US
Mailing Address - Phone:503-750-4937
Mailing Address - Fax:
Practice Address - Street 1:13235 SW GLENHAVEN ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-0958
Practice Address - Country:US
Practice Address - Phone:503-750-4937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN000896363LF0000X
OR200850013NP363LF0000X
WAAP60048456363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV103358Medicare PIN