Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 10195563 | OR |
NPI | 1154852226 |
---|---|
Provider Name | Jessica West Vining |
First Address | Keizer, OR 97303-6034 |
Second Address | Portland, OR 97216-2809 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2017 |
Last Update Date | 04/11/2021 |