Individual
AURORA LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ACNP
Contact information
Practice address
335 SE 8TH AVE, HILLSBORO, OR 97123-4248
(503) 681-1111
(503) 681-4066
Mailing address
720 HARRION AVE, DOB 503, BOSTON, MA 02118-1207
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
202001095NP-PP
OR
363LA2100X
Acute Care Nurse Practitioner
RN2291759
MA
363LG0600X
Gerontology Nurse Practitioner
202001095NP-PP
OR
363LG0600X
Gerontology Nurse Practitioner
RN2291759
MA
Other
Enumeration date
03/03/2017
Last updated
09/20/2024
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