Provider Demographics
NPI:1053779488
Name:FIBROMYALGIA FOCUS, INC
Entity type:Organization
Organization Name:FIBROMYALGIA FOCUS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HRYCIW
Authorized Official - Suffix:
Authorized Official - Credentials:MS, FNP
Authorized Official - Phone:971-344-8600
Mailing Address - Street 1:1675 SW MARLOW AVE STE 210B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5162
Mailing Address - Country:US
Mailing Address - Phone:503-389-3106
Mailing Address - Fax:503-546-4223
Practice Address - Street 1:1675 SW MARLOW AVE
Practice Address - Street 2:SUITE 210B
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5104
Practice Address - Country:US
Practice Address - Phone:503-389-3106
Practice Address - Fax:503-546-4223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-30
Last Update Date:2017-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200150080363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR180604OtherMEDICARE PTAN