Individual
RAYNA DONNELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9735 SW SHADY LN STE 102, TIGARD, OR 97223
(503) 620-5614
Mailing address
9735 SW SHADY LN STE 102, TIGARD, OR 97223-5481
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA185400
OR
Other
Enumeration date
04/11/2018
Last updated
07/25/2018
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