Individual
KIMBERLEY LA MORTICELLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
WHNP-BC
Contact information
Practice address
6027 SE PARDEE ST, PORTLAND, OR 97206-4756
(503) 887-6482
Mailing address
6027 SE PARDEE ST, PORTLAND, OR 97206-4756
(503) 887-6482
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
202109521NP-PP
OR
Other
Enumeration date
12/29/2021
Last updated
12/29/2021
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