Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 092006710N3 ANP-PP | OR |
NPI | 1003239666 |
---|---|
Provider Name | Ms. Kim Schlessinger |
First Address | Corvallis, OR 97330-3737 |
Second Address | Corvallis, OR 97330-3737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2014 |
Last Update Date | 31/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R15527 | (02) | OR |