Provider Demographics
NPI:1316952815
Name:HRYCIW, CHERYL ANN (FNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:HRYCIW
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1675 SW MARLOW AVE
Mailing Address - Street 2:SUITE 210B
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5104
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200150080NP363LF0000X
OR080045607RN363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213388Medicaid
OR213388Medicaid