Individual
VANESSA LANDIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
417 SW 117TH AVE STE 200, PORTLAND, OR 97225-5924
(503) 216-9400
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA205599
OR
363AM0700X
Medical Physician Assistant
PA205599
OR
Other
Enumeration date
05/02/2020
Last updated
06/09/2023
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