Individual
PATRICIA MCCUSKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1312 SW WASHINGTON ST, PORTLAND, OR 97205-2327
(503) 535-1151
(503) 546-8340
Mailing address
1312 SW WASHINGTON ST, PORTLAND, OR 97205-2327
(503) 535-1151
(503) 546-8340
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
2395422
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MXW2126D
—
OR
Enumeration date
12/30/2016
Last updated
12/30/2016
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