Individual
THERESA M RARDIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
24900 SE STARK ST STE 208, GRESHAM, OR 97030-3382
(503) 666-8149
Mailing address
4432 NE CESAR E CHAVEZ BLVD, PORTLAND, OR 97211-8232
(503) 867-0019
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA182032
OR
Other
Enumeration date
04/17/2017
Last updated
04/17/2017
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