Provider Demographics
NPI:1841627528
Name:RADFORD, TAMI L (FNP-C)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:L
Last Name:RADFORD
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:L
Other - Last Name:PEARCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:831 NW COUNCIL DR STE 125
Mailing Address - Street 2:
Mailing Address - City:GRESHAM
Mailing Address - State:OR
Mailing Address - Zip Code:97030-3794
Mailing Address - Country:US
Mailing Address - Phone:503-661-3439
Mailing Address - Fax:
Practice Address - Street 1:831 NW COUNCIL DR STE 125
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030
Practice Address - Country:US
Practice Address - Phone:503-661-3439
Practice Address - Fax:503-669-1360
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201805467NP363LF0000X
UT189082-4405363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily