Individual
MRS. KRISTINA MARIE DWYHALO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSPA
Contact information
Practice address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
(503) 571-4222
Mailing address
9900 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9777
(503) 571-3495
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA170407
OR
363A00000X
Physician Assistant
PA60514736
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
857733
—
AZ
Enumeration date
09/25/2013
Last updated
01/16/2015
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