Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 1717 | CA |
NPI | 1134290406 |
---|---|
Provider Name | Amber Lee Zietz |
First Address | Portland, OR 97225-6623 |
Second Address | Portland, OR 97225-6623 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2006 |
Last Update Date | 06/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN608299 | (05) | CA |