Individual
MATTHEW DAVID FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AAS
Contact information
Practice address
13317 SE POWELL BLVD, PORTLAND, OR 97236-3335
(503) 760-9606
(503) 760-9609
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
(503) 963-7711
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
201140738RN
OR
Other
Enumeration date
06/16/2011
Last updated
06/16/2011
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