Individual
MRS. ANGELINA LUCRETIA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPCP
Contact information
Practice address
191 NE GRAND AVE, PORTLAND, OR 97232-2936
(971) 337-5401
Mailing address
191 NE GRAND AVE, PORTLAND, OR 97232-2936
(971) 337-5401
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
BAP-TA-10190322
OR
Other
Enumeration date
05/08/2018
Last updated
05/08/2018
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