Individual
KURTIS A PHILLIPI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3745 SE 317TH AVE, TROUTDALE, OR 97060-9401
(503) 663-1436
(503) 663-1545
Mailing address
745 SE 17TH ST, TROUTDALE, OR 97060-2247
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
200930555LPN
OR
Other
Enumeration date
06/18/2017
Last updated
06/18/2017
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