Individual
BRIANA NICOLE KETTERER REVOAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 494-8311
Mailing address
7505 SE 22ND AVE UNIT A, PORTLAND, OR 97202-6258
(480) 227-7075
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD467138
PA
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
Primary
MD177704
OR
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
MD467138
PA
Other
Enumeration date
03/25/2014
Last updated
06/22/2020
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