Individual
TARA LYNNE HEENEY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
5005 NE SANDY BLVD, PORTLAND, OR 97213-1941
(503) 233-6940
Mailing address
800 SW 13TH AVE, PORTLAND, OR 97205
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO173008
OR
Other
Enumeration date
04/11/2012
Last updated
10/19/2020
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