Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | OR |
NPI | 1083885552 |
---|---|
Provider Name | Melanie C Lakaemper |
First Address | Portland, OR 97206-2248 |
Second Address | Portland, OR 97206-2248 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/03/2008 |
Last Update Date | 12/03/2008 |