Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 202006706NP-PP | OR |
NPI | 1003425489 |
---|---|
Provider Name | A'lissa Richards |
First Address | Portland, OR 97216-3737 |
Second Address | Portland, OR 97216-3737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2020 |
Last Update Date | 30/07/2020 |