Organization
KELLY WASHBURN, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZABETH PONDOLFINO (MEDICAL OFFICE MANAGER)
(971) 328-0083
Entity
Organization
Contact information
Practice address
5935 SE BELMONT ST, PORTLAND, OR 97215-1925
(541) 638-0261
(833) 520-1522
Mailing address
5935 SE BELMONT ST, PORTLAND, OR 97215-1925
(541) 638-0261
(833) 520-1522
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500689145
—
OR
Enumeration date
02/04/2022
Last updated
02/04/2022
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