Individual provider · NPI-1

Marissa Autumn Abdallah

Case Manager/Care Coordinator · Portland, OR

NPI number1679047575
StatusActive
Last updated in NPPESJan 15, 2019

Details

NPI
1679047575
Entity type
Individual (NPI-1)
Name
Marissa Autumn Abdallah
Sex
Female
Sole proprietor
Yes
Enumeration date
Jan 15, 2019
Last updated
Jan 15, 2019

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
171M00000X Case Manager/Care Coordinator–ORYes

Practice location

11035 Ne Sandy Blvd
Portland, OR 97220-2553

Phone 503-258-4690

Mailing address

11035 Ne Sandy Blvd
Portland, OR 97220-2553

Phone 503-258-4690

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