Provider Demographics
NPI:1740859297
Name:FAWCETT, DANIELA (FNP-C)
Entity type:Individual
Prefix:
First Name:DANIELA
Middle Name:
Last Name:FAWCETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DANIELA
Other - Middle Name:
Other - Last Name:FAWCETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:15352 SE ARROWHEAD PL
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7379
Mailing Address - Country:US
Mailing Address - Phone:310-384-6520
Mailing Address - Fax:
Practice Address - Street 1:5200 MEADOWS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-0086
Practice Address - Country:US
Practice Address - Phone:855-255-1750
Practice Address - Fax:855-255-0905
Is Sole Proprietor?:No
Enumeration Date:2021-06-20
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61522042363L00000X, 363LF0000X
OR10019434363LF0000X, 363L00000X
CA95017430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily