Individual
MATTIE KHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5209 N VANCOUVER AVE UNIT 11F, PORTLAND, OR 97217-2784
(503) 935-3493
Mailing address
5209 N VANCOUVER AVE UNIT 11F, PORTLAND, OR 97217-2784
(503) 935-3493
Taxonomy
Speciality
Code
Description
License number
State
374J00000X
Doula
Primary
800
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW0183
TRADITIONAL HEALTH WORKER
OR
Enumeration date
02/23/2016
Last updated
02/23/2016
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