Provider Demographics
NPI:1306505540
Name:BURCH, CHRISTIANN AUTUMN (HLC)
Entity type:Individual
Prefix:
First Name:CHRISTIANN
Middle Name:AUTUMN
Last Name:BURCH
Suffix:
Gender:F
Credentials:HLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 MCVEY AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-4502
Mailing Address - Country:US
Mailing Address - Phone:503-421-9999
Mailing Address - Fax:
Practice Address - Street 1:4400 NE HALSEY ST FL 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1545
Practice Address - Country:US
Practice Address - Phone:503-421-9999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-15
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker