Individual
SALLY R YIRKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1940 SE 80TH AVE, APT. 19, PORTLAND, OR 97215-3676
(503) 758-1148
Mailing address
1940 SE 80TH AVE, APT. 19, PORTLAND, OR 97215-3676
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
200930515LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200930515LPN
LPN LICENSE
OR
Enumeration date
07/13/2010
Last updated
07/13/2010
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