Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 086006932N2 | OR |
NPI | 1023059441 |
---|---|
Provider Name | Laurie C Carmichael |
First Address | Eugene, OR 97402-0451 |
Second Address | Eugene, OR 97401-8122 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 12/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
117841 | (05) | OR |
S92302 | (02) |