Individual
LORELIE A VARDANEGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 413-4121
Mailing address
6312 SW CAPITOL HWY, #502, PORTLAND, OR 97239-1938
(503) 464-9034
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
MD23740
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
139437
—
OR
Enumeration date
07/21/2006
Last updated
07/08/2007
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