Individual
DR. DIANE VINES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., R.N.,
Contact information
Practice address
3880 SE 8TH AVE, SUITE 110, PORTLAND, OR 97202-3772
(503) 819-4285
Mailing address
3880 SE 8TH AVE, SUITE 110, PORTLAND, OR 97202-3772
(503) 819-4285
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
200140577RN
OR
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
198331
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
198331
R.N. LICENSE AND PSYCH NURSE PRACTITIONER INACTIVE
CA
01
—
200140577RN
R.N. LICENSE
OR
Enumeration date
02/04/2010
Last updated
02/04/2010
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