Provider Demographics
NPI:1750603338
Name:DUVALL, CHERYL ANN (RN, LMT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:DUVALL
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19365 SW 65TH AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:TUALATIN
Mailing Address - State:OR
Mailing Address - Zip Code:97062-9196
Mailing Address - Country:US
Mailing Address - Phone:503-699-7674
Mailing Address - Fax:503-699-7759
Practice Address - Street 1:19365 SW 65TH AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9196
Practice Address - Country:US
Practice Address - Phone:503-699-7674
Practice Address - Fax:503-699-7759
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3858261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR3858OtherLMT LICENSE
CA280922OtherRN LICENSE
089006398RNOtherRN LICENSE