Individual
CASEY GRAD GRANBOIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
812 SW WASHINGTON ST, PORTLAND, OR 97205-3222
(503) 622-8964
Mailing address
3225 SE 69TH AVE, PORTLAND, OR 97206-1948
(503) 421-0235
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202100056
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/30/2019
Last updated
04/19/2021
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