Individual
JOAN NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2606 NE BROADWAY ST, SUITE C, PORTLAND, OR 97232-1898
(503) 292-9560
(503) 292-9510
Mailing address
9450 SW BARNES RD, SUITE 100, PORTLAND, OR 97225-6619
(503) 292-9560
(503) 292-9510
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA00882
OR
363A00000X
Physician Assistant
Primary
PA10004118
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8326217
—
WA
Enumeration date
07/17/2006
Last updated
05/25/2012
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