Individual
JACEY N WALROD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
10000 SE MAIN ST STE 224, PORTLAND, OR 97216-2469
(503) 261-6961
Mailing address
10000 SE MAIN ST STE 224, PORTLAND, OR 97216-2469
(503) 261-6961
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA207078
OR
Other
Enumeration date
09/23/2021
Last updated
10/26/2021
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