Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEMLD10136025 | OR |
NPI | 1114246683 |
---|---|
Provider Name | Ms. Allison Jean Mahnke |
First Address | Portland, OR 97203-2029 |
Second Address | Portland, OR 97203-2029 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2010 |
Last Update Date | 07/12/2021 |