Provider Demographics
NPI:1962557355
Name:IRVING, PETER (QMHA)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:IRVING
Suffix:
Gender:M
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 SW RIVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-3148
Mailing Address - Country:US
Mailing Address - Phone:503-956-4490
Mailing Address - Fax:
Practice Address - Street 1:310 NW FLANDERS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3941
Practice Address - Country:US
Practice Address - Phone:503-827-3949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered372600000XNursing Service Related ProvidersAdult Companion