Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 176B00000X | Midwife | 201604395NP-PP | OR |
NPI | 1023435336 |
---|---|
Provider Name | Emily Zeno Yeast |
First Address | Portland, OR 97208-3777 |
Second Address | Portland, OR 97227-1671 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2014 |
Last Update Date | 29/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500713232 | (05) | OR |