Individual
MARY BURNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
9135 SW BARNES RD STE 875, PORTLAND, OR 97225-6683
(503) 297-3440
Mailing address
8614 E MILL PLAIN BLVD, STE 400, VANCOUVER, WA 98664-2092
(541) 728-1019
(360) 254-6089
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA170904
OR
Other
Enumeration date
01/07/2015
Last updated
10/26/2020
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