Individual
IRENA MATTINGLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
6214 SE MILWAUKIE AVE, PORTLAND, OR 97202-5417
(503) 908-6616
(225) 351-9980
Mailing address
6812 SE DREW ST, MILWAUKIE, OR 97222-1830
(503) 707-4064
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
10007639
OR
Other
Enumeration date
05/02/2023
Last updated
11/04/2024
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