Individual
IAN LUX
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN-BSN
Contact information
Practice address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
(503) 255-4205
Mailing address
722 NE 162ND AVE, PORTLAND, OR 97230
(503) 255-4205
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
201508364RN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201508364RN
NURSING LICENSE
OR
Enumeration date
02/02/2016
Last updated
02/02/2016
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