Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 099006806N2 | OR |
NPI | 1023161270 |
---|---|
Provider Name | Kathleen Mary Glover |
First Address | Portland, OR 97204-2347 |
Second Address | Portland, OR 97204-2347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E54235 | (02) | OR |