Individual
TAYLOR ALYSA POTTRATZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
123 C AVE, LAKE OSWEGO, OR 97034-2353
(503) 905-9006
(541) 210-8913
Mailing address
123 C AVE, LAKE OSWEGO, OR 97034-2353
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA204779
OR
Other
Enumeration date
05/03/2019
Last updated
10/04/2021
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