Individual
MS. MICHELLE MEILANIE HARSONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
501 N GRAHAM ST, SUITE 420, PORTLAND, OR 97227-1654
(503) 288-7303
(503) 288-3806
Mailing address
847 NE 19TH AVE, SUITE 300, PORTLAND, OR 97232-2684
(503) 963-2801
(503) 963-2825
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
PA155408
OR
363AS0400X
Surgical Physician Assistant
Primary
PA155408
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500641881
—
OR
Enumeration date
05/05/2011
Last updated
10/05/2015
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