Individual
NHU NGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
501 N GRAHAM ST STE 420, PORTLAND, OR 97227-2006
(503) 288-7303
Mailing address
541 NE 20TH AVE STE 225, PORTLAND, OR 97232-2895
(503) 963-2801
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA219530
OR
Other
Enumeration date
06/11/2024
Last updated
06/19/2024
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