Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 201150165NP | OR |
N | 363LA2200X | Nurse Practitioner - Adult Health | AP30006102 | WA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | AP30006102 | WA |
NPI | 1174561468 |
---|---|
Provider Name | Mr. Mark E Puhlman |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97225-6629 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/06/2006 |
Last Update Date | 12/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
AP30006102 | STATE ARNP LICENSE (01) | WA |
MP0954594 | DEA (01) | WA |
RN00081896 | STATE REGISTERED NURSE (01) | WA |