Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 001741 | OR |
N | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | NP 091007250N6 | OR |
NPI | 1013005792 |
---|---|
Provider Name | Alan P Kaiser |
First Address | Portland, OR 97219-2039 |
Second Address | Portland, OR 97219-2039 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
077938 | (05) | OR |