BROOKLEY VALENTINE HOLTER PAC NPI 1710968375

NPI Information

NPI: 1710968375
Provider Name: BROOKLEY VALENTINE HOLTER, PAC
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
3101 SW SAM JACKSON PARK RD
SHRINER'S HOSPITAL FOR CHILDREN
PORTLAND, OR
ZIP 97239
Phone: (503) 221-3428
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Brookley Valentine Holter, PAC is a surgical physician assistant in Portland, OR. Brookley Valentine Holter, PAC NPI is 1710968375. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

3101 SW SAM JACKSON PARK RD
SHRINER'S HOSPITAL FOR CHILDREN
PORTLAND, OR
ZIP 97239
Phone: (503) 221-3428
Fax: (503) 221-3490

The NPI 1710968375 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 11/10/2005 and was last updated on 12/14/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	PA00818	OREGON	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	P00186774	OTHER		RR MEDICARE
2	0192176	OTHER	WASHINGTON	WA LABOR INDUSTRIES
3	080727006	OTHER	OREGON	REGENCE BCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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