Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 390200000X | OR |
N | 111NI0900X | Internist | 390200000X | OR |
NPI | 1003012618 |
---|---|
Provider Name | Ginevra Lois Liptan |
First Address | Portland, OR 97221-1459 |
Second Address | Portland, OR 97221-1459 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2007 |
Last Update Date | 13/10/2011 |