Individual
DR. DANIEL DOMINIC ERIC ROA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DNP, ARNP-PP, AGPCNP
Contact information
Practice address
5316 N GREELEY AVE, PORTLAND, OR 97217-4113
(541) 720-8789
Mailing address
5316 N GREELEY AVE, PORTLAND, OR 97217-4113
(541) 720-8789
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
201507350NP-PP
OR
363LG0600X
Gerontology Nurse Practitioner
Primary
201507350NP-PP
OR
Other
Enumeration date
09/29/2015
Last updated
09/29/2015
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