Individual
LINK IAM LAITHREACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 666-6575
Mailing address
8765 SW CORTEZ CT, BEAVERTON, OR 97008-7285
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201406614RN
OR
Other
Enumeration date
05/16/2017
Last updated
05/16/2017
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