Individual
EBONY SKYE FENN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
324 NW DAVIS ST, PORTLAND, OR 97209-3925
(503) 226-2203
Mailing address
324 NW DAVIS ST, PORTLAND, OR 97209-3925
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
201394683LPN
OR
Other
Enumeration date
12/19/2023
Last updated
12/19/2023
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