Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD102953 | OR |
NPI | 1104957307 |
---|---|
Provider Name | Carol A Severson |
First Address | Albany, OR 97322-5211 |
Second Address | Albany, OR 97322-6934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140058 | (05) | OR |
98040016 | NARM (01) | OR |
LDM-LD 102953 | HEALTH LICENSING BOARD (01) | OR |