Individual
MONICA K MYKLEBUST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
16180 SE SUNNYSIDE RD, SUITE 102, HAPPY VALLEY, OR 97015-6301
(503) 582-4900
(503) 582-4999
Mailing address
P.O. BOX 3158, PORTLAND, OR 97208-3158
(503) 215-6494
(503) 215-6644
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4301081301
MI
207Q00000X
Family Medicine Physician
Primary
MD28074
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
242654
—
OR
05
—
4505746
—
MI
Enumeration date
10/11/2006
Last updated
03/22/2021
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