Individual
MISS JOLIE ROSANNE DIETZEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-7641
(503) 494-8368
Mailing address
3181 SW SAM JACKSON PARK RD., MAIL CODE SJH-2, PORTLAND, OR 97239-3011
(503) 494-4910
(503) 494-8368
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201703087RN
OR
367500000X
Certified Registered Nurse Anesthetist
Primary
202000077CRNA
OR
Other
Enumeration date
09/14/2017
Last updated
03/13/2020
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