Provider Demographics
NPI:1780077750
Name:BACH, BROOKLYN (NP)
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3181 SW SAM JACKSON PARK RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3011
Mailing Address - Country:US
Mailing Address - Phone:503-494-5058
Mailing Address - Fax:503-494-1552
Practice Address - Street 1:OHSU MEDICINE HEMATOLOGY & MEDICAL ONCOLOGY
Practice Address - Street 2:3181 SW SAM JACKSON PARK RD; L586
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-8584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-14
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY687345163W00000X
MA2304378163W00000X
OR201800724NP-PP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse