Provider Demographics
NPI:1770812117
Name:DAVIES, ADRIAN RAWSON (FNP)
Entity type:Individual
Prefix:
First Name:ADRIAN
Middle Name:RAWSON
Last Name:DAVIES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:ADRIAN
Other - Middle Name:ELIZABETH
Other - Last Name:RAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 NE 99TH AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-9442
Mailing Address - Country:US
Mailing Address - Phone:503-963-2707
Mailing Address - Fax:
Practice Address - Street 1:1111 NE 99TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-9428
Practice Address - Country:US
Practice Address - Phone:503-963-2707
Practice Address - Fax:503-963-2802
Is Sole Proprietor?:No
Enumeration Date:2009-12-14
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620806363LF0000X
NC5014280363LF0000X
OR201250057NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1770812117Medicaid
OR500657127Medicaid
OR164763Medicare PIN
WA1770812117Medicaid