Individual
VICKI COLLISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-4620
(503) 215-4846
Mailing address
PO BOX 3178, PORTLAND, OR 97208-3178
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
087000014N3
OR
Other
Enumeration date
07/11/2006
Last updated
07/08/2007
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