Individual
MR. JONATHAN RYAN FORDYCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
417 SW 117TH AVE, PORTLAND, OR 97225-5924
(503) 216-8980
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
AP137863
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500760115
—
OR
Enumeration date
07/11/2018
Last updated
03/09/2021
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