Individual
JUN MA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
4805 NE GLISAN ST STE 11N, PORTLAND, OR 97213-2933
(503) 215-2075
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
201050108NP
OR
367A00000X
Advanced Practice Midwife
201050108NP
OR
Other
Enumeration date
09/27/2010
Last updated
03/22/2021
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