Individual
NICI MYRA CLAYMON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
4927 NE 30TH AVE, PORTLAND, OR 97211-7007
(503) 281-0681
(503) 335-6258
Mailing address
4927 NE 30TH AVE, PORTLAND, OR 97211-7007
(503) 281-0681
(503) 335-6258
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
18849
OR
Other
Enumeration date
06/29/2012
Last updated
06/29/2012
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