Individual
BROOKLEY VALENTINE HOLTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
3101 SW SAM JACKSON PARK RD, SHRINER'S HOSPITAL FOR CHILDREN, PORTLAND, OR 97239
(503) 221-3428
(503) 221-3490
Mailing address
PO BOX 8500, LOCKBOX 7642, SHRINER'S HOSPITALS FOR CHILDREN PORTLAND, PHILADELPHIA, PA 19178-7642
(813) 281-8115
(813) 281-8656
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00818
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0192176
WA LABOR INDUSTRIES
WA
01
—
080727006
REGENCE BCBS
OR
01
—
P00186774
RR MEDICARE
—
Enumeration date
11/10/2005
Last updated
12/14/2017
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