Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | LC-10189339 | OR |
NPI | 1336606862 |
---|---|
Provider Name | Jessica Gaskill |
First Address | Portland, OR 97211-7234 |
Second Address | Portland, OR 97211-7234 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2019 |
Last Update Date | 20/02/2019 |