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Individual

SAMANTHA LARAE FEAGINS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
722 NE 162ND AVE, PORTLAND, OR 97230-5760
(503) 239-8101
Mailing address
424 NE 22ND AVE, PORTLAND, OR 97232-2809
(503) 239-8101
(503) 408-5201

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201906305
OR

Other

Enumeration date
08/04/2019
Last updated
08/04/2019
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