Individual
AGNES WHITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP, LAC
Contact information
Practice address
421 SW OAK ST, STE. 210, PORTLAND, OR 97204-1817
(503) 988-7468
Mailing address
11211 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-7787
(503) 659-0880
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
AC150310
OR
363L00000X
Nurse Practitioner
Primary
096000382N1
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
096511
—
OR
05
—
22959
—
OR
Enumeration date
05/24/2006
Last updated
12/12/2013
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