Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | DO23519 | OR |
NPI | 1033177886 |
---|---|
Provider Name | Dr. Jennifer L Letourneau |
First Address | Portland, OR 97210-3025 |
Second Address | Portland, OR 97210-3025 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2006 |
Last Update Date | 01/09/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1120518 | (05) | WA |
H84604 | (02) |