Individual
MARY LISA SHELLEY PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 573-8663
Mailing address
4101 NE DIVISION ST, GRESHAM, OR 97030-4617
(503) 573-8663
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
201243125RN
OR
Other
Enumeration date
08/27/2025
Last updated
08/27/2025
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