Individual
JESSE ELI STANLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8772
Mailing address
6842 NE MORRIS ST, PORTLAND, OR 97213-5246
(208) 854-9160
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
201603541RN
OR
Other
Enumeration date
03/17/2020
Last updated
03/17/2020
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