Individual
DOROTHEA BRAXTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 813-7727
Mailing address
3415 SE POWELL BLVD, PORTLAND, OR 97202-3371
(503) 813-7727
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
201040116RN
OR
Other
Enumeration date
03/01/2012
Last updated
03/01/2012
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