Graduated: 2016
NPI: 1669929758
Practice Locations (2)
PROVIDENCE HEALTH AND SERVICES OREGON
4004 KRUSE WAY PL, SUITE 300
LAKE OSWEGO, OR 970352479
5032161500
PROVIDENCE HEALTH AND SERVICES OREGON
5050 NE HOYT ST, SUITE 454
PORTLAND, OR 972132984
5032156405
Source: CMS National Downloadable File, September 2026.