Provider Demographics
NPI:1053806901
Name:FLURY, CHANNING DANAE (PMHNP)
Entity type:Individual
Prefix:
First Name:CHANNING
Middle Name:DANAE
Last Name:FLURY
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10121 SE SUNNYSIDE RD STE 300-3474
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5745
Mailing Address - Country:US
Mailing Address - Phone:971-570-0299
Mailing Address - Fax:
Practice Address - Street 1:10121 SE SUNNYSIDE RD STE 300-3474
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-5745
Practice Address - Country:US
Practice Address - Phone:971-570-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-23
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201802933RN163W00000X
OR10036487363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse