Individual
DEZIRAE MICHELLE SANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
3710 SW US VETERANS HOSPITAL RD, PORTLAND, OR 97239-2964
(503) 721-1028
Mailing address
4025 N MONTANA AVE, PORTLAND, OR 97227-1123
(503) 961-0851
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
10011219
OR
Other
Enumeration date
07/12/2023
Last updated
07/12/2023
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