Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2080P0210X | Pediatric Nephrologist | MD00038073 | WA |
Y | 2080P0210X | Pediatric Nephrologist | MD18994 | OR |
NPI | 1699877258 |
---|---|
Provider Name | Jeanne Mowry |
First Address | Portland, OR 97227-1196 |
Second Address | Portland, OR 97227-1196 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2006 |
Last Update Date | 04/02/2022 |