Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201250003NP | OR |
NPI | 1013190081 |
---|---|
Provider Name | Miss Kristin Lois Cummings |
First Address | Portland, OR 97204-1817 |
Second Address | Portland, OR 97211-3237 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 09/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
022959 | (05) | OR |
096511 | (05) | OR |