Emily Grace Douglass Fernando, PNP
Nurse Practitioner, Pediatrics in Portland, OR. Individual provider (NPI-1).
NPI number1982304630
StatusActive
Last updated in NPPESFeb 14, 2025
Details
- NPI
- 1982304630
- Entity type
- Individual (NPI-1)
- Name
- Emily Grace Douglass Fernando
- Credential
- PNP
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Mar 9, 2023
- Certification date
- Feb 14, 2025
- Last updated
- Feb 14, 2025
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LP0200X | Nurse Practitioner, Pediatrics | 10000858 | OR | Yes |
| 2080P0008X | Pediatrics, Neurodevelopmental Disabilities | 10000858 | OR |
Other names
- Emily G Douglass (Former Name)
Practice location
830 Ne 47th AvePortland, OR 97213-2212
Phone 503-216-2339
Mailing address
Po Box 3158Portland, OR 97208-3158
Phone 503-215-6494
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