Individual
KELLY BRISTOL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3314 NE 29TH AVE, PORTLAND, OR 97212-2536
(503) 509-1743
Mailing address
3314 NE 29TH AVE, PORTLAND, OR 97212-2536
(503) 509-1743
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
041-306683
IL
Other
Enumeration date
03/17/2025
Last updated
03/17/2025
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