Individual
ROBERTA KORNBLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
R.N.
Contact information
Practice address
3034 NE M L KING BLVD, PORTLAND, OR 97212-3053
(503) 283-3763
Mailing address
13333 S GLENN DR, MULINO, OR 97042-9635
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
086006572RN
OR
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
01/29/2007
Last updated
07/02/2008
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