Individual
MICHAEL THOMAS VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-1111
Mailing address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-1111
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN170524
AZ
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
10023628
OR
367500000X
Certified Registered Nurse Anesthetist
Primary
9161774
ID
Other
Enumeration date
06/14/2019
Last updated
02/11/2026
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