Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | MD23675 | OR |
NPI | 1255346771 |
---|---|
Provider Name | Dana Kostiner Simpson |
First Address | Portland, OR 97219-1146 |
Second Address | San Bernardino, CA 92408-4162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2006 |
Last Update Date | 04/02/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
286496 | (05) | OR |