Individual
TANYA NEELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4550 KRUSE WAY STE 125, LAKE OSWEGO, OR 97035-3533
(503) 369-3135
(855) 790-9134
Mailing address
131 MCKALL CT, KELSO, WA 98626-2256
(360) 749-9120
(855) 790-9134
Taxonomy
Speciality
Code
Description
License number
State
163WC0200X
Critical Care Medicine Registered Nurse
60137227
WA
363LF0000X
Family Nurse Practitioner
Primary
AP61127888
WA
Other
Enumeration date
06/23/2020
Last updated
05/27/2025
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