Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 397548 | OR |
NPI | 1023518784 |
---|---|
Provider Name | Ashli Ann Hatfield |
First Address | Roseburg, OR 97470-3158 |
Second Address | Roseburg, OR 97470-3158 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/02/2018 |
Last Update Date | 19/02/2018 |