Individual
MRS. KENDRA ELIZABETH GAUMITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
10330 SE 32ND AVE STE 110, PORTLAND, OR 97222-6596
(503) 513-1300
Mailing address
321 STEELHEAD ST, MOLALLA, OR 97038-7635
(503) 732-5348
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201805821LPN
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
201805821LPN
OSBN
OR
Enumeration date
02/10/2020
Last updated
02/10/2020
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