Individual
ELLEN L. IWASAKI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4411 SW VERMONT ST, PORTLAND, OR 97219-1020
(503) 494-9992
Mailing address
4411 SW VERMONT ST, PORTLAND, OR 97219-1020
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
085074555N1
OR
363LF0000X
Family Nurse Practitioner
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039375
—
OR
Enumeration date
07/31/2006
Last updated
07/08/2007
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