Individual
MARY LARSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4531 SE BELMONT ST STE 100, PORTLAND, OR 97215-1675
(503) 548-2948
Mailing address
4531 SE BELMONT ST STE 100, PORTLAND, OR 97215-1675
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
087000131RN
OR
Other
Enumeration date
06/09/2016
Last updated
06/09/2016
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