Individual
MRS. ROBERTA NADINE VANDENTOP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1815 SW MARLOW AVE, STE 110, PORTLAND, OR 97225-5185
(503) 296-0918
(503) 296-6158
Mailing address
14807 NW APPLEGATE LN, PORTLAND, OR 97229-1899
(503) 747-2572
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
10/18/2006
Last updated
07/08/2007
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