Individual
MADDISON SOUZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
11782 SW BARNES RD STE 300, PORTLAND, OR 97225-5933
(503) 214-5200
(503) 906-6613
Mailing address
588 LONGMEADOW ST, LONGMEADOW, MA 01106-2212
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA221312
OR
Other
Enumeration date
07/05/2022
Last updated
07/10/2024
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