Individual
MALLORY KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8643 NE BEECH ST, PORTLAND, OR 97220-5012
(503) 256-2151
Mailing address
2380 19TH ST, WEST LINN, OR 97068-4068
(503) 250-3356
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201130139LPN
OR
Other
Enumeration date
12/19/2022
Last updated
12/19/2022
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