Individual
SONAN DABA ITCHA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
X
Credential
FNP
Contact information
Practice address
6551 SE PINE CREEK WAY, MILWAUKIE, OR 97267-1928
(614) 772-8120
Mailing address
6551 SE PINE CREEK WAY, MILWAUKIE, OR 97267-1928
(614) 772-8120
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
10043886
OR
Other
Enumeration date
04/28/2025
Last updated
04/28/2025
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