Search › Oregon › 175T00000X
Modupe Bansile
NPI 1790133031 · on the registry since 2016 · sole proprietor
Practice
- Address
- 209 Sw Fourth Ave, Suite 520
Portland, OR 97204 - Phone
- (541) 556-9195
- Clinicians at this address
- 2
Additional practice sites
- 707 Ne Couch St, Portland, OR
- 445 Port Ave, Saint Helens, OR
- 209 Sw Fourth Ave, Suite 520, Portland, OR
Registry record
- Primary taxonomy
- 175T00000X
175T00000X
- Also registered as
- 101Y00000X
- Licence states on file
- OR
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2018-10-30
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Oregon