Individual
BRUCE L EASTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP
Contact information
Practice address
15 N MORRIS ST, PORTLAND, OR 97227-1541
(503) 230-9875
(503) 230-9877
Mailing address
1776 SW MADISON ST, CREDENTIALING DEPARTMENT, PORTLAND, OR 97205-1715
(971) 386-2278
(503) 224-4494
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201403164RN
OR
163W00000X
Registered Nurse
RN00142133
WA
363LF0000X
Family Nurse Practitioner
Primary
201403166NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500680533
—
OR
Enumeration date
08/29/2012
Last updated
02/09/2017
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