Individual
MRS. MARIE ANN COULSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14988 SE DIVISION ST, PORTLAND, OR 97236-2337
(503) 960-1511
Mailing address
14988 SE DIVISION ST, PORTLAND, OR 97236-2337
(503) 960-1511
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
13
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
743962
—
OR
05
—
811695
—
OR
Enumeration date
05/11/2016
Last updated
03/09/2018
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