Individual
AMY KERALY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1005 NE 112TH AVE, PORTLAND, OR 97220-3170
(503) 583-3545
Mailing address
1005 NE 112TH AVE, PORTLAND, OR 97220-3170
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201030223LPN
OR
Other
Enumeration date
07/28/2011
Last updated
07/28/2011
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