Individual
MS. DIANE M COCKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
3600 N INTERSTATE AVE, PORTLAND, OR 97227-1106
(503) 331-6500
(503) 331-6505
Mailing address
3600 N INTERSTATE AVE, PORTLAND, OR 97227-1106
(503) 331-6500
(503) 331-6505
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
200250099
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100111
—
OR
Enumeration date
10/03/2006
Last updated
12/21/2021
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