Individual
COURTNEY ANN MCCALLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN PMHNP
Contact information
Practice address
14305 SW 112TH AVE, PORTLAND, OR 97224-3705
(503) 660-2418
Mailing address
14305 SW 112TH AVE, PORTLAND, OR 97224-3705
(503) 660-2418
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
200841828RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10025683
OR
Other
Enumeration date
08/15/2008
Last updated
05/02/2024
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