Individual
MRS. PRISCILLA DESVERGUNAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 276-9300
(503) 276-9351
Mailing address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 276-9300
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
202109745NP
OR
Other
Enumeration date
09/21/2021
Last updated
09/21/2021
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