Individual
INEKE J GLAVOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1321 NE 99TH AVE STE 200, PORTLAND, OR 97220-9439
(503) 215-4250
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA156455
OR
Other
Enumeration date
01/05/2012
Last updated
02/12/2021
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