Individual
TREVA SAKURA DRAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1111 NW NAITO PKWY, PORTLAND, OR 97209-2596
(503) 488-7720
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
201909401RN
OR
Other
Enumeration date
01/15/2020
Last updated
01/15/2020
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