Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | H3197 | TX |
N | 207RP1001X | Pulmonary Disease | H3197 | TX |
Y | 207RP1001X | Pulmonary Disease | MD24778 | OR |
NPI | 1073561650 |
---|---|
Provider Name | Juliette Louise Wait |
First Address | Portland, OR 97232-2684 |
Second Address | Portland, OR 97225-6667 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2006 |
Last Update Date | 11/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117055704 | (05) | TX |
2059836 | (05) | WA |
500707189 | (05) | OR |
G28487 | (02) | |
P00881737 | RAILROAD MEDICARE (01) | TX |