Individual
TRAVIS R TIEDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
12360 SE SUNNYSIDE RD, CLACKAMAS, OR 97015-9320
(503) 303-4000
Mailing address
11827 SE WHITE TAIL DR, HAPPY VALLEY, OR 97086-4722
(612) 703-5277
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10016365
OR
Other
Enumeration date
03/04/2024
Last updated
03/04/2024
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