Provider Demographics
NPI:1912002775
Name:FYFE, CHRISTINA E (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:E
Last Name:FYFE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:CHRISTINA
Other - Middle Name:E
Other - Last Name:VENN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18610 NW CORNELL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-9204
Practice Address - Country:US
Practice Address - Phone:503-216-9360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMV0765428363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672338Medicaid
ORP01393359OtherRR MEDICARE - PHS
ORR175866Medicare PIN
ORR175682Medicare PIN
OR500672338Medicaid
ORR175863Medicare PIN
ORP01393359OtherRR MEDICARE - PHS
ORR175864Medicare PIN