Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEMLD10162477 | OR |
NPI | 1043630122 |
---|---|
Provider Name | Cristyl Dawn Garner |
First Address | Portland, OR 97266-4235 |
Second Address | Portland, OR 97266-4235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 16/04/2014 |