Individual
JOYCE SOUTHALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2631 N MISSISSIPPI AVE, PORTLAND, OR 97227-1616
(503) 528-2140
(503) 335-8125
Mailing address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
(503) 533-0152
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
00019514RN
OR
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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