Individual
EVNICA I KOROTKIKH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6428 SE JENNINGS AVE, PORTLAND, OR 97267-6317
(360) 936-3519
Mailing address
6428 SE JENNINGS AVE, PORTLAND, OR 97267-6317
(360) 936-3519
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/05/2021
Last updated
04/05/2021
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