Individual
ERIN VON BURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LE
Contact information
Practice address
2646 NE GLISAN ST, PORTLAND, OR 97232-2318
(503) 459-6438
Mailing address
2646 NE GLISAN ST, PORTLAND, OR 97232-2318
(503) 459-6438
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10193842
OR
Other
Enumeration date
05/06/2024
Last updated
05/06/2024
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