Individual
ELLIE RAINES BOARDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15074 SE BEVINGTON AVE, MILWAUKIE, OR 97267
(503) 307-0159
Mailing address
15074 SE BEVINGTON AVE, MILWAUKIE, OR 97267
(503) 307-0159
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
199221
—
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
01/13/2021
Last updated
01/20/2021
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