Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 201701726NP-PP | OR |
N | 363LG0600X | Nurse Practitioner - Gerontology | AP60689189 | WA |
NPI | 1063961373 |
---|---|
Provider Name | Elisabeth Romatz Mahmud |
First Address | Corvallis, OR 97330 |
Second Address | Corvallis, OR 97330-3737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2016 |
Last Update Date | 08/11/2017 |