Individual
NICOLLE A RENFRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
200 S HAZEL DELL WAY STE 205, CANBY, OR 97013-7828
(503) 405-3700
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA218913
OR
Other
Enumeration date
10/06/2014
Last updated
05/28/2025
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