Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | DO154075 | OR |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | DO154075 | OR |
NPI | 1831148196 |
---|---|
Provider Name | Marjorie Nicole Harvill-Brooks |
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 | 06/05/2006 |
Last Update Date | 15/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
500634857 | MEDICAID (01) | OR |