Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 27 3158 | OR |
NPI | 1104803238 |
---|---|
Provider Name | Dr. Ann Zukauskas |
First Address | Gresham, OR 97080-7276 |
Second Address | Portland, OR 97225-1692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2005 |
Last Update Date | 08/09/2019 |