Individual
SALLY ROTHACKER PEYTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRNCS, PMH-NP
Contact information
Practice address
619 NW 6TH AVE FL 3, PORTLAND, OR 97209-3964
(503) 988-3663
(503) 988-4098
Mailing address
619 NW 6TH AVE FL 5, PORTLAND, OR 97209-3964
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R042060
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
123350000
—
ME
Enumeration date
12/14/2005
Last updated
11/26/2019
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