Individual
JASON SOUTHMAYD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N.
Contact information
Practice address
4105 SE INTERNATIONAL WAY STE 501, MILWAUKIE, OR 97222-8855
(503) 496-3201
Mailing address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
(503) 690-9605
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201504773RN
OR
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
201504773RN
OR
Other
Enumeration date
07/14/2016
Last updated
07/14/2016
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