Individual
LAURIE MERLINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3550 N INTERSTATE AVE, PORTLAND, OR 97227-1196
(800) 813-2000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
OR PA00827
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500601385
—
OR
01
—
P00787100
RR MEDICARE-PH&S
OR
Enumeration date
10/04/2006
Last updated
12/12/2019
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