Individual
SALLIE TISDALE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4531 SE BELMONT ST, PORTLAND, OR 97215-1675
(503) 519-2633
Mailing address
4205 NE DAVIS ST, PORTLAND, OR 97213-1631
(503) 519-2633
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
083037585
OR
Other
Enumeration date
09/13/2012
Last updated
09/13/2012
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