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General NPI Number Information
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NPI Number | 1841054368
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Entity Type | Organization
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Legal Business Name | SANDRA J KRUSSEL DO PSYCHIATRIST LLC
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Dates
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Enumeration Date | 02/07/2024
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 2250 NW FLANDERS ST STE 306
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City | PORTLAND
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State | OR
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Zip | 97210-5411
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Country | US
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Telephone | 503-276-1297
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Fax | 503-206-0613
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Provider Business Mailing Address
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Address Line | 2250 NW FLANDERS ST STE 306
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City | PORTLAND
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State | OR
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Zip | 97210-5411
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Country | US
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Telephone | 503-276-1297
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Fax | 503-206-0613
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. SANDRA JANE KRUSSEL
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Credential | DO
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Telephone | 503-276-1297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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