Individual
MRS. JWANA B IBSIES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 505-2373
Mailing address
12866 SW MORNINGSTAR DR, TIGARD, OR 97223-1784
(503) 505-2373
Taxonomy
Speciality
Code
Description
License number
State
242T00000X
Perfusionist
Primary
089004
OR
Other
Enumeration date
07/01/2020
Last updated
07/01/2020
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