Individual
ALEXANDER KOLLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPN
Contact information
Practice address
10330 SE 32ND AVE STE 110, MILWAUKIE, OR 97222-6596
(503) 525-8199
Mailing address
10330 SE 32ND AVE STE 110, MILWAUKIE, OR 97222-6596
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201507450LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201507450LPN
LPN LICENSE
OR
Enumeration date
01/11/2016
Last updated
01/11/2016
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