Organization
PROVIDENCE PORLAND MEDICAL CENTER
Active
Other names
Providence Health System
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERRI LYNN EELLS (RN/NURSE PRACTITIONER STUDENT)
15032156150
Entity
Organization
Contact information
Practice address
4805 NE GLISAN ST, PORTLAND, OR 97213-2933
(503) 215-1111
Mailing address
312 ENGLE AVE, MOLALLA, OR 97038-9138
(150) 335-1019
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
09000464RN
OR
Other
Enumeration date
08/27/2007
Last updated
08/27/2007
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