Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD-1002847 | OR |
NPI | 1053520288 |
---|---|
Provider Name | Coeli Dwivedi |
First Address | Ashland, OR 97520-1008 |
Second Address | Ashland, OR 97520-1008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 14/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
269634 | (05) | OR |