Individual
MR. GLEN ALAN KENOSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ARNP
Contact information
Practice address
3710 SW US VETERANS RD, PORTLAND, OR 97207
(503) 220-8262
(360) 737-1419
Mailing address
1819 NE 66TH ST, VANCOUVER, WA 98665-0367
(360) 737-8986
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
088006537N3
OR
Other
Enumeration date
09/25/2006
Last updated
07/08/2007
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