Individual
MRS. DIANE MICHELLE JENSEN-RUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
2330 NW FLANDERS ST, SUITE 205, PORTLAND, OR 97210-3442
(503) 957-8885
Mailing address
2330 NW FLANDERS ST, SUITE 205, PORTLAND, OR 97210-3442
(503) 957-8885
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
7404
OR
Other
Enumeration date
11/14/2006
Last updated
07/08/2007
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