Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | A114185 | CA |
Y | 2084N0400X | Neurologist | MD175459 | OR |
NPI | 1548402811 |
---|---|
Provider Name | Dr. Juliette Sophie Preston |
First Address | Portland, OR 97239 |
Second Address | Portland, OR 97239-4501 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2009 |
Last Update Date | 11/01/2016 |