Brockway, David

Brockway, David is an sole proprietor health care provider with primary practice located at 17455 Sw 108Th Pl , Tualatin OR 97062-8427. He recently has only one registered license in Nursing Service Related Providers / Attendant Care Provider, which is considered as his primary health care specialty. Brockway, David can be contacted via phone (503) 298-1935.

Contact Information

Primary practice address
17455 Sw 108Th Pl Tualatin OR 97062-8427
Fax:
Website:

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Related Providers / Attendant Care Provider 3747A0650X

Profile Details

NPI number 1154963692
LBN Legal business name Brockway, David
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 16th, 2019
Last updated Oct 16th, 2019 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1154963692 NPPES
Oregon MEDICAID DZ1386

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