Individual
KYLINE NICOLE FARWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
5050 NE HOYT ST STE 626, PORTLAND, OR 97213-2956
(503) 917-3950
Mailing address
6015 N INTERSTATE AVE APT 441, PORTLAND, OR 97217-4792
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA201995
OR
363A00000X
Physician Assistant
—
—
Other
Enumeration date
03/04/2020
Last updated
10/08/2020
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