Individual
IMANI ANDERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
434 NE ROSELAWN ST, PORTLAND, OR 97211-3826
(503) 919-5652
Mailing address
17704 NE GLISAN ST, PORTLAND, OR 97230-6504
(503) 919-5652
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000
DONT HAVE A NUMBER
—
05
—
0000
—
OR
Enumeration date
10/30/2018
Last updated
11/07/2020
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