Individual
JON NICOLE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
7705 SE DIVISION ST, PORTLAND, OR 97206-1059
(503) 777-3311
(503) 777-5466
Mailing address
241 SE 55TH AVE, PORTLAND, OR 97215-1169
(503) 230-0971
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
OR PA00516
OR
Other
Enumeration date
11/07/2006
Last updated
07/08/2007
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