Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD-10160095 | OR |
N | 176B00000X | Midwife | MW60477681 | WA |
NPI | 1073764536 |
---|---|
Provider Name | Angela Danae Beach-Hart |
First Address | Portland, OR 97206-1217 |
Second Address | Portland, OR 97206-1217 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2008 |
Last Update Date | 29/12/2014 |