Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 10290 | HI |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | MD154890 | OR |
NPI | 1407946577 |
---|---|
Provider Name | Dr. Ellen Marie Raney |
First Address | Philadelphia, PA 19178-7642 |
Second Address | Portland, OR 97239-3009 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 12/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MD154890 | LICENSE (01) | OR |