Individual
HAYLIE MOON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
4405 SW PRIMROSE ST, PORTLAND, OR 97219-5235
(503) 440-9278
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201804644RN
OR
Other
Enumeration date
07/02/2018
Last updated
07/02/2018
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