Individual
MS. JULIE A PROCTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
24800 SE STARK ST, GRESHAM, OR 97030-3378
(503) 674-1122
Mailing address
4233 SE 182ND AVE STE 362, GRESHAM, OR 97030-5082
(503) 807-8006
(503) 658-2864
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200650016NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000494
—
OR
Enumeration date
09/22/2006
Last updated
11/12/2019
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