Individual
MUSAH N IDDRISU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
12710 SE DIVISION ST, PORTLAND, OR 97236-3134
(503) 988-3601
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3964
(503) 988-7468
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
10017169
OR
Other
Enumeration date
10/21/2020
Last updated
11/07/2023
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