Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | MD14772 | OR |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | MD14772 | OR |
NPI | 1841387313 |
---|---|
Provider Name | Lanita C Witt |
First Address | Portland, OR 97208-3158 |
Second Address | Medford, OR 97504-6193 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2006 |
Last Update Date | 13/10/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
181370 | (05) | OR |