Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LC1500X | Nurse Practitioner - Community Health | 201392158NP | OR |
NPI | 1386812329 |
---|---|
Provider Name | Miranda L Foust |
First Address | Happy Valley, OR 97086-7641 |
Second Address | Happy Valley, OR 97086-7641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2008 |
Last Update Date | 04/12/2018 |