Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD-10170627 | OR |
NPI | 1164891321 |
---|---|
Provider Name | Emlia Megtaleena Smith |
First Address | Portland, OR 97213-6123 |
Second Address | Portland, OR 97213-6123 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2015 |
Last Update Date | 17/09/2015 |