Travis R Tiede, APRN
Nurse Practitioner, Psych/Mental Health in Clackamas, OR. Individual provider (NPI-1).
NPI number1962269332
StatusActive
Last updated in NPPESMar 4, 2024
Details
- NPI
- 1962269332
- Entity type
- Individual (NPI-1)
- Name
- Travis R Tiede
- Credential
- APRN
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Mar 4, 2024
- Certification date
- Mar 3, 2024
- Last updated
- Mar 4, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0808X | Nurse Practitioner, Psych/Mental Health | 10016365 | OR | Yes |
Practice location
12360 Se Sunnyside RdClackamas, OR 97015-9320
Phone 503-303-4000
Mailing address
11827 Se White Tail DrHappy Valley, OR 97086-4722
Phone 612-703-5277
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