Provider Demographics
NPI:1942987482
Name:ASSURE PSYCHIATRY INC
Entity Type:Organization
Organization Name:ASSURE PSYCHIATRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:NJIDEKA
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMRUFUS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:817-524-7107
Mailing Address - Street 1:511 SW 10TH AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2707
Mailing Address - Country:US
Mailing Address - Phone:971-244-8844
Mailing Address - Fax:
Practice Address - Street 1:511 SW 10TH AVE STE 601
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2707
Practice Address - Country:US
Practice Address - Phone:971-244-8844
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty