Individual
DOMINIQUE LEE HARGROVE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNA/CMA
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 234-9591
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
200910567CNA
OR
Other
Enumeration date
06/22/2015
Last updated
06/22/2015
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