Individual
VLADIMIR NIKOLAYEVICH CHERNYSHEV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1130 NW 22ND AVE, PORTLAND, OR 97210-2900
(503) 229-7137
Mailing address
1790 SE BUSH ST, HILLSBORO, OR 97123-5017
(503) 927-0884
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201330050LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
YVA140152313
REGENCE
OR
Enumeration date
08/04/2017
Last updated
08/04/2017
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