Individual
ALEXANDER PHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1350 NE 122ND AVE, PORTLAND, OR 97230
(503) 408-7008
Mailing address
1350 NE 122ND AVE, PORTLAND, OR 97230-2011
(503) 408-7008
(503) 408-7045
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
201900297NP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274147
—
OR
Enumeration date
06/11/2013
Last updated
04/14/2019
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