Individual
LAURA E RENNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
300 N GRAHAM ST, PORTLAND, OR 97227-1683
(503) 413-4134
(503) 413-1895
Mailing address
300 N GRAHAM ST, SUITE 200, PORTLAND, OR 97227-1683
(503) 413-4134
(503) 413-1895
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
000033925N3
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500003758
RR PIN #
—
05
—
77206
—
OR
Enumeration date
05/17/2006
Last updated
07/08/2007
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