Individual
MARY ELLEN SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-4500
(503) 494-1678
Mailing address
1400 SW 5TH AVE STE 500, PORTLAND, OR 97201-5537
(866) 617-6855
(503) 346-8015
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
025656
NY
363AM0700X
Medical Physician Assistant
Primary
PA217576
OR
363L00000X
Nurse Practitioner
025656
NY
Other
Enumeration date
02/01/2021
Last updated
04/09/2024
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