Individual
BRENDA DAVIS IRVINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN, IBCLC
Contact information
Practice address
1304 SE 58TH AVE, PORTLAND, OR 97215-2728
(503) 701-1180
Mailing address
1304 SE 58TH AVE, PORTLAND, OR 97215-2728
(503) 701-1180
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
078041248
OR
Other
Enumeration date
10/15/2019
Last updated
10/15/2019
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