Individual
MIRIAM MCMAHON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1117 SE 122ND AVE, PORTLAND, OR 97233-1160
(503) 946-8633
Mailing address
1117 SE 122ND AVE, PORTLAND, OR 97233-1160
(503) 946-8633
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
10/21/2012
Last updated
10/21/2012
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