Individual
CHRISTINA DYNAMITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
33 NW BROADWAY, PORTLAND, OR 97209
(503) 228-7134
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(971) 271-6307
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
201601943RN
OR
163W00000X
Registered Nurse
201601943RN
OR
Other
Enumeration date
11/17/2016
Last updated
08/22/2018
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