Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 201802224RN | OR |
Y | 363LA2100X | Nurse Practitioner - Acute Care | 202113265NP-PP | OR |
NPI | 1033880901 |
---|---|
Provider Name | Alexander Fong |
First Address | Portland, OR 97227-2014 |
Second Address | Portland, OR 97227-2014 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2021 |
Last Update Date | 17/11/2021 |