Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 200050038NP/ANP | OR |
NPI | 1013956036 |
---|---|
Provider Name | Ms. Maria R. Clark-Harmon |
First Address | Corvallis, OR 97339-1189 |
Second Address | Corvallis, OR 97330-4744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 06/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P32408 | (02) | OR |