Individual
LAUREN REBECCA HOLMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7400
(503) 494-4749
Mailing address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7400
(503) 494-4749
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA186509
OR
363AM0700X
Medical Physician Assistant
PA.200824
LA
363AM0700X
Medical Physician Assistant
Primary
PA186509
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05056736
—
MS
05
—
2398393
—
LA
Enumeration date
09/17/2012
Last updated
12/22/2020
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