Individual
LEATIVA TUANEI NICHOLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5107 N MICHIGAN AVE, PORTLAND, OR 97217-2516
(503) 750-3501
Mailing address
5107 N MICHIGAN AVE, PORTLAND, OR 97217-2516
(503) 750-3501
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
09/21/2021
Last updated
09/21/2021
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