Individual
LAURA DILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
10822 SE 82ND AVE, HAPPY VALLEY, OR 97086
(503) 239-8400
Mailing address
1027 E BURNSIDE ST, PORTLAND, OR 97214-1328
(503) 239-8400
(503) 296-2022
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201142492RN
OR
363LF0000X
Family Nurse Practitioner
201705362NP-PP
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201705362NP-PP
OR
Other
Enumeration date
01/11/2014
Last updated
06/04/2024
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