Individual
PHYLLIS DESHUN HURSEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1206 SE 11TH AVE, PORTLAND, OR 97214-3601
(503) 389-1166
(503) 389-1161
Mailing address
13215 SE MILL PLAIN BLVD STE C8, VANCOUVER, WA 98684-6999
(503) 269-2409
(503) 389-1161
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
MD26240
OR
207Q00000X
Family Medicine Physician
Primary
MD26240
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MD26240
LICENCE
OR
Enumeration date
01/27/2006
Last updated
12/08/2021
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