Individual
MICHAEL UDALL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-1111
Mailing address
2211 E 18TH ST, VANCOUVER, WA 98661-4013
(480) 528-4550
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
10041156
OR
363LA2100X
Acute Care Nurse Practitioner
Primary
10041156
OR
Other
Enumeration date
05/20/2026
Last updated
06/01/2026
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