Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD-10156092 | OR |
NPI | 1073950036 |
---|---|
Provider Name | Aimee A Disharoon |
First Address | Medford, OR 97504-6808 |
Second Address | Medford, OR 97504-6808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2013 |
Last Update Date | 31/05/2013 |