Individual
KELSEY TANAKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
839 NE HOLLADAY ST, PORTLAND, OR 97232-3521
(503) 203-0700
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202206538NP-PP
OR
363LF0000X
Family Nurse Practitioner
A162206
IA
363LF0000X
Family Nurse Practitioner
AP60687964
WA
Other
Enumeration date
09/10/2016
Last updated
11/21/2023
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