Individual
EVA CICILIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ADVANCE PRACTICE RN
Contact information
Practice address
1410 NE 106TH AVE, PORTLAND, OR 97220-3934
(503) 460-0405
Mailing address
PO BOX 8459, PORTLAND, OR 97207-8459
(503) 238-0769
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
201142770RN
OR
171M00000X
Case Manager/Care Coordinator
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
202006868NP-PP
OR
Other
Enumeration date
07/23/2019
Last updated
08/05/2020
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