Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0401X | Internist - Addiction Medicine | DO197830 | OR |
NPI | 1528417169 |
---|---|
Provider Name | Ellen Mooney |
First Address | Portland, OR 97227-1885 |
Second Address | Portland, OR 97227-1885 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2016 |
Last Update Date | 11/01/2022 |