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1316580509
MARK DUANE ELLIS
PORTLAND, OR
NPI
1316580509
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
164W00000X Licensed Practical Nurse
(Licence: OR 098005066LPN)
Enumeration Date
2019-10-21
Last Update Date
2019-10-21
Business Address
MARK DUANE ELLIS
2600 SE BELMONT ST
PORTLAND, OR 97214-2916
Phone number: 503-239-5738
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Mailing Address
MARK DUANE ELLIS
2600 SE BELMONT ST
PORTLAND, OR 97214-2916
Phone number: 503-239-5738
Copy
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