Individual
BRENDA LYNN GROSSNICKLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNS
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 220-8262
Mailing address
9410 SE NICHOLAS DR, HAPPY VALLEY, OR 97086-7350
Taxonomy
Speciality
Code
Description
License number
State
364S00000X
Clinical Nurse Specialist
Primary
201808009CNS-PP
OR
Other
Enumeration date
12/22/2018
Last updated
12/22/2018
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