Provider Demographics
NPI:1245019314
Name:QUESENBERRY, RICHARD ALAN (LPN)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
Last Name:QUESENBERRY
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 NW DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97209-3925
Mailing Address - Country:US
Mailing Address - Phone:503-226-2203
Mailing Address - Fax:
Practice Address - Street 1:324 NW DAVIS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97209-3925
Practice Address - Country:US
Practice Address - Phone:971-645-4690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202001517LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse