Individual
NITHYA KALYANI KRISHNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 666-6575
Mailing address
1331 NE 46TH AVE, PORTLAND, OR 97213-2121
(415) 730-4068
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
12/05/2025
Last updated
12/05/2025
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