Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 3945 | OR |
NPI | 1588991764 |
---|---|
Provider Name | Ann Marie King Tarr |
First Address | Portland, OR 97236-2345 |
Second Address | Portland, OR 97236-2345 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2009 |
Last Update Date | 10/11/2009 |