Individual
LUCY NUSRALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.-C
Contact information
Practice address
4212 NE BROADWAY ST, PORTLAND, OR 97213-1422
(503) 249-8787
Mailing address
4212 NE BROADWAY ST, PORTLAND, OR 97213-1422
(503) 249-8787
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01448
OR
Other
Enumeration date
10/20/2005
Last updated
05/08/2014
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