Graduated: 2008
NPI: 1194963025
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
440 NW DIVISION ST
GRESHAM, OR 970305506
5032159500
PROVIDENCE HEALTH AND SERVICES OREGON
5050 NE HOYT ST, SUITE 240
PORTLAND, OR 972132981
5032156480
Source: CMS National Downloadable File, September 2026.