Individual
JOHN MICHAEL ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
1321 NE 99TH AVE STE 100, PORTLAND, OR 97220-9437
(503) 215-9900
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201390532NP-PP
OR
Other
Enumeration date
07/18/2013
Last updated
06/09/2023
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