Individual
EMILY BALLOU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
13007 NE GLISAN ST, PORTLAND, OR 97230-2545
(503) 914-7783
Mailing address
13007 NE GLISAN ST, PORTLAND, OR 97230-2545
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201130221LPN
OR
Other
Enumeration date
11/05/2019
Last updated
11/05/2019
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