Individual
SYRENA NICHOLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
7721 SE 92ND AVENUE, APT K, PORTLAND, OR 97266
(415) 672-1319
Mailing address
7721 SE 92ND AVE, APT K, PORTLAND, OR 97266-6227
(415) 672-1319
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
20848
OR
Other
Enumeration date
02/06/2015
Last updated
02/06/2015
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