Individual
MICHAEL A. BRODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-6176
Mailing address
2537 NE 48TH AVE, PORTLAND, OR 97213-1923
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
297915
—
OR
Enumeration date
01/23/2007
Last updated
07/08/2007
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