Individual
MR. RANDALL DAVID RUGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
7105 SW VARNS ST STE 270, PORTLAND, OR 97223-8173
(503) 389-1500
Mailing address
4207 SE WOODSTOCK BLVD # 429, PORTLAND, OR 97206-6267
(503) 682-5000
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202210677NP-PP
OR
Other
Enumeration date
07/20/2022
Last updated
07/20/2022
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