Individual
MARY VAANDERING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
17221 SE DIVISION ST, S-21, PORTLAND, OR 97236-1240
(503) 760-0778
Mailing address
3354 SW BEAVERTON HILLSDALE HWY, PORTLAND, OR 97239-6901
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
17996
OR
Other
Enumeration date
11/16/2012
Last updated
11/16/2012
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