Healthcare Provider Details

I. General information

NPI: 1558812438
Provider Name (Legal Business Name): KRISTINA LOUIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 10/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5211 NE GLISAN ST BUILDING C
PORTLAND OR
97213-3052
US

IV. Provider business mailing address

5211 NE GLISAN ST BUILDING C
PORTLAND OR
97213-3052
US

V. Phone/Fax

Practice location:
  • Phone: 503-215-5368
  • Fax: 503-215-6240
Mailing address:
  • Phone: 503-215-5368
  • Fax: 503-215-6240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: