Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | L-57374 | VA |
NPI | 1295130656 |
---|---|
Provider Name | Carrie Cohen |
First Address | Portland, OR 97217-6707 |
Second Address | Portland, OR 97217-6243 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2014 |
Last Update Date | 05/03/2015 |