Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0208X | Pediatric Infectious Diseases | MD27045 | OR |
NPI | 1285609917 |
---|---|
Provider Name | Dr. Dawn Lynn Nolt |
First Address | Portland, OR 97239-3011 |
Second Address | Portland, OR 97239-3011 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 07/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001873678 | (05) | PA |
H54723 | (02) | PA |