Individual
MRS. DONNISSA SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
THE BEAUTY THRONE
Contact information
Practice address
117 SE 129TH AVE, PORTLAND, OR 97233-1503
(971) 806-9549
Mailing address
117 SE 129TH AVE, PORTLAND, OR 97233-1503
(971) 806-9549
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
COS-HA-10154523
OR
Other
Enumeration date
03/27/2019
Last updated
03/27/2019
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