Individual
TINA ASHLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14201 E BURNSIDE ST, NUMBER 32, PORTLAND, OR 97233-1884
(503) 970-5622
Mailing address
14201 E BURNSIDE ST, NUMBER 32, PORTLAND, OR 97233-1884
(503) 970-5622
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27-3895138
TAX ID
OR
Enumeration date
12/27/2010
Last updated
12/27/2010
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