Individual
VICKIE ELLEN ROTHROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3011
(503) 418-5710
Mailing address
2228 NE 22ND AVE, PORTLAND, OR 97212-4711
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
082010299N2
OR
363LP0200X
Pediatric Nurse Practitioner
—
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
276684
—
OR
Enumeration date
07/31/2006
Last updated
07/08/2007
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