Individual
MARK DUANE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2600 SE BELMONT ST, PORTLAND, OR 97214-2916
(503) 239-5738
(503) 963-9026
Mailing address
2600 SE BELMONT ST, PORTLAND, OR 97214-2916
(503) 239-5738
(503) 963-9026
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
098005066LPN
OR
Other
Enumeration date
10/21/2019
Last updated
10/21/2019
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