Individual
MS. TERI MARIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
377 NW JASPER ST, DALLAS, OR 97338-1279
(503) 623-5581
Mailing address
2386 E ELLENDALE AVE, DALLAS, OR 97338-9352
(503) 409-2930
Taxonomy
Speciality
Code
Description
License number
State
163WG0600X
Gerontology Registered Nurse
Primary
097000186RN
OR
Other
Enumeration date
12/03/2009
Last updated
12/03/2009
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