Individual
BREANNA LYNN BAKER NOWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5050 NE HOYT ST STE 240, PORTLAND, OR 97213-2981
(503) 215-6480
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA170541
OR
363AM0700X
Medical Physician Assistant
PA170541
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500712175
—
OR
Enumeration date
12/26/2014
Last updated
08/30/2021
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