Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | MD17337 | OR |
NPI | 1104807908 |
---|---|
Provider Name | Cynthia Sue Nocek |
First Address | Salem, OR 97304-4049 |
Second Address | Salem, OR 97304-4049 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 07/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
023015 | (05) | OR |
E67090 | (02) | OR |