Individual
DIANA ELIZABETH GWINN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DD1
Contact information
Practice address
16405 NE FARGO CIR, PORTLAND, OR 97230-5513
(503) 484-7287
(503) 210-5974
Mailing address
16405 NE FARGO CIR, PORTLAND, OR 97230-5513
(503) 484-7287
(503) 210-5974
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
10465
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500745787
—
OR
Enumeration date
07/30/2018
Last updated
07/30/2018
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