Individual
RYAN TATEISHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11740 SW 68TH PKWY STE 200, TIGARD, OR 97223-9058
(425) 477-4216
Mailing address
117 NW 8TH ST, MCMINNVILLE, OR 97128-5560
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
RN60364120
WA
363L00000X
Nurse Practitioner
201900796NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
201900796NP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201900796NP-PP
OR
Other
Enumeration date
02/05/2018
Last updated
03/25/2024
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