Individual
MISS DOMINIQUE DEROSA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN BSN
Contact information
Practice address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
(503) 645-3581
Mailing address
14600 NW CORNELL RD, PORTLAND, OR 97229-5442
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201392570RN
OR
Other
Enumeration date
09/05/2017
Last updated
09/05/2017
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