Individual
MARK M PROCHNAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSN, CRNA
Contact information
Practice address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 571-6386
Mailing address
10180 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-8970
(503) 571-6386
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201240512RN
OR
367500000X
Certified Registered Nurse Anesthetist
Primary
201260049CRNA
OR
Other
Enumeration date
06/13/2012
Last updated
09/26/2012
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