Individual
LOGAN GRACESON KNIGHT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4212 SE DIVISION ST STE 100, PORTLAND, OR 97206-1680
(503) 238-0705
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
10010965
OR
Other
Enumeration date
05/20/2024
Last updated
05/20/2024
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