Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | MD 13946 | OR |
NPI | 1649695917 |
---|---|
Provider Name | Dr. Stephanie Harris |
First Address | Springfield, OR 97477-8800 |
Second Address | Springfield, OR 97477-8800 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2014 |
Last Update Date | 24/02/2014 |