Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD-10171645 | OR |
NPI | 1154790863 |
---|---|
Provider Name | Katrina Bubas Stevens |
First Address | Portland, OR 97266-5712 |
Second Address | Portland, OR 97266-5712 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2015 |
Last Update Date | 23/09/2015 |