Individual
ANGELA MASSONI-BLAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2222 NW LOVEJOY ST, PORTLAND, OR 97210-3033
(503) 413-8036
Mailing address
2222 NW LOVEJOY ST, PORTLAND, OR 97210-3033
(503) 413-8036
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
201910414NP-PP
OR
363LA2200X
Adult Health Nurse Practitioner
23638
CA
Other
Enumeration date
11/01/2013
Last updated
08/26/2020
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