Individual
CARLY JACQUELINE GRIFFIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1111 NE 99TH AVE STE 200, PORTLAND, OR 97220-9442
(503) 963-3030
(503) 963-3140
Mailing address
847 NE 19TH AVE STE 300, PORTLAND, OR 97232-2686
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201705874NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2084641
—
WA
05
—
500730448
—
OR
Enumeration date
05/01/2015
Last updated
11/16/2021
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