Graduated: 2018
NPI: 1639730666
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
4400 NE HALSEY ST
PORTLAND, OR 972131545
PROVIDENCE HEALTH AND SERVICES OREGON
5050 NE HOYT ST, SUITE 454
PORTLAND, OR 972132984
5032156405
Source: CMS National Downloadable File, September 2026.