Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2200X | Nurse Practitioner - Adult Health | 200550107NP | OR |
N | 363LA2200X | Nurse Practitioner - Adult Health | AP30007105 | WA |
Y | 363LW0102X | Nurse Practitioner - Women's Health | 200550108NP | OR |
N | 363LW0102X | Nurse Practitioner - Women's Health | AP30007105 | WA |
NPI | 1033151667 |
---|---|
Provider Name | Mrs. Elisabeth Hayden Holt Makler |
First Address | Portland, OR 97223-8692 |
Second Address | Portland, OR 97225-6663 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 21/06/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
278822 | (05) | OR |
9656042 | (05) | WA |
R186769 | MEDICARE PTAN (01) | OR |