Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | DO19288 | OR |
Y | 207Q00000X | Family Doctor | DO19288 | OR |
NPI | 1427157932 |
---|---|
Provider Name | Dr. Janice Upton Blumer |
First Address | Corvallis, OR 97339-1193 |
Second Address | Lebanon, OR 97355-2875 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2006 |
Last Update Date | 17/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F65279 | (02) |