Individual
KATHERINE KUSMAUL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN-PMHNP
Contact information
Practice address
905 SE 14TH AVE, PORTLAND, OR 97214-2569
(503) 622-8964
Mailing address
905 SE 14TH AVE, PORTLAND, OR 97214-2569
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
163W00000X
Registered Nurse
RN61385886
WA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10018655
OR
Other
Enumeration date
12/30/2021
Last updated
11/14/2023
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