Doctor Name: | NELL THYRZA RAFALOVICH |
NPI Number: | 1144626953 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA174450 |
Business Practice Address: | 3426 Doubletree St Forest Grove, OR - 971162972 |
Business Phone Number: | 5039282941 |
Business Fax Number: | |
Mailing Address: | 1825 Maple St, FOREST GROVE |
State: | OR |
Postal Code: | 971161939 |
Phone Number: | 5033572136 |
Fax Number: | 5033595479 |
NPI Enumeration Date: | 11/06/2014 |
NPI Last Update Date: | 09/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA174450 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |