Individual
BRENNA HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18101 SW BOONES FERRY RD STE 250, PORTLAND, OR 97224-7655
(503) 734-7764
Mailing address
2847 UPPER DR, LAKE OSWEGO, OR 97035-3663
(503) 734-7764
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BAP-E-10237269
OR
Other
Enumeration date
11/09/2023
Last updated
11/09/2023
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