Individual
ELLA CLARK-NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3303 SW BOND AVE, PORTLAND, OR 97239-4501
(503) 494-8573
(503) 494-3457
Mailing address
3906 SW KANAN DR, PORTLAND, OR 97221-3433
(206) 617-4095
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA01168
OR
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
11/14/2006
Last updated
02/08/2021
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