Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 200750075NP | OR |
NPI | 1003969643 |
---|---|
Provider Name | Andrew E Vilius |
First Address | Gresham, OR 97030-7418 |
Second Address | Gresham, OR 97030-7418 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 13/01/2021 |