Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 096007164N3 | OR |
NPI | 1033165188 |
---|---|
Provider Name | Deidre Weiler |
First Address | Portland, OR 97216-2455 |
Second Address | Portland, OR 97216-2455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/07/2007 |