Individual
BRIANNA ELIZABETH-O'MARA COSTELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-8573
(503) 494-3457
Mailing address
3303 S BOND AVE, PORTLAND, OR 97239-4501
(503) 494-8573
(503) 494-3457
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA196976
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2145869
—
WA
05
—
500773250
—
OR
Enumeration date
12/06/2019
Last updated
10/04/2021
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