Individual
JAY TARAN WALKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
X
Credential
RN, MSN, AGPCNP-C
Contact information
Practice address
17727 E BURNSIDE ST, PORTLAND, OR 97233-4803
(503) 215-9800
Mailing address
17727 E BURNSIDE ST, PORTLAND, OR 97233-4803
(503) 215-9800
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
201243683RN
OR
363LA2200X
Adult Health Nurse Practitioner
201906834NP-PP
OR
363LG0600X
Gerontology Nurse Practitioner
Primary
201906834NP-PP
OR
Other
Enumeration date
01/11/2018
Last updated
10/25/2024
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