Individual
MR. WILLIAM PERVISKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
5926 SE 15TH AVE., PORTLAND, OR 97202
(503) 458-6463
Mailing address
PO BOX 82104, PORTLAND, OR 97282-0104
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201141329RN
OR
Other
Enumeration date
08/03/2011
Last updated
08/03/2011
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