Individual
JAIME ETHAN BIAVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP
Contact information
Practice address
5228 NE HOYT ST BLDG B2ND, PORTLAND, OR 97213
(503) 215-4860
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201504133NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500693864
—
OR
Enumeration date
08/07/2015
Last updated
02/05/2021
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