Individual
KAITLYN TOMIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(515) 321-8960
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8311
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
201505718
OR
363LA2100X
Acute Care Nurse Practitioner
Primary
201505718NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201505718
OREGON STATE BOARD OF NURSING
OR
Enumeration date
08/13/2015
Last updated
11/09/2023
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