Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 7029 | OR |
Y | 213EG0000X | General Practice | 7029 | OR |
NPI | 1003368028 |
---|---|
Provider Name | Michelle R Lawrence |
First Address | Portland, OR 97239-4552 |
Second Address | Portland, OR 97239-4552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2016 |
Last Update Date | 25/10/2016 |