Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 091000527N3 ANP-PP | OR |
NPI | 1003920109 |
---|---|
Provider Name | Ms. Lakshi Marie Aldredge |
First Address | Portland, OR 97207-1034 |
Second Address | Portland, OR 97239-2964 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 12/07/2007 |