Individual
COURTNEY ANNE ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2200 NE NEFF RD STE 200, BEND, OR 97701-4281
(541) 382-3344
Mailing address
450 N GRAHAM ST, PORTLAND, OR 97227-1682
(503) 413-4488
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA194379
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
12/16/2018
Last updated
06/24/2022
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