Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 14440 | OR |
NPI | 1174659353 |
---|---|
Provider Name | Ms. Kathleen Anne Kennedy |
First Address | Portland, OR 97219-8462 |
Second Address | Portland, OR 97225-6603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2007 |
Last Update Date | 08/07/2007 |