Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD-10132944 | OR |
NPI | 1104158823 |
---|---|
Provider Name | Mrs. Sarah M Lax |
First Address | Portland, OR 97206-7020 |
Second Address | Portland, OR 97214-5246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2010 |
Last Update Date | 22/10/2013 |