Individual
ELNORA WEATHERSPOON GRANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213
(503) 215-1111
Mailing address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
AP60903125
WA
363L00000X
Nurse Practitioner
Primary
201809398NP-PP
OR
Other
Enumeration date
08/31/2016
Last updated
03/29/2019
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