Individual
BRENDA ANN LAVIGNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3181 SW SAM JACKSON PARK RD STE 430, PORTLAND, OR 97239
(503) 494-1627
(503) 346-8285
Mailing address
3181 SW SAM JACKSON PARK RD STE 430, PORTLAND, OR 97239-3011
(503) 494-1624
(503) 346-8285
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1128895
OR
363A00000X
Physician Assistant
PA174984
OR
363AS0400X
Surgical Physician Assistant
Primary
PA174984
OR
Other
Enumeration date
09/16/2014
Last updated
04/10/2020
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