Individual
SODASAVANH JOY KHAMSOUKTHAVONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
501 N GRAHAM ST STE 220, PORTLAND, OR 97227-2014
(503) 413-4710
(503) 413-7148
Mailing address
501 N GRAHAM ST STE 220, PORTLAND, OR 97227-2014
(503) 413-4710
(503) 413-7148
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
200570006CNS
OR
Other
Enumeration date
05/11/2016
Last updated
12/21/2018
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