Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LW0102X | Nurse Practitioner - Women's Health | 200650009NP | OR |
NPI | 1093820698 |
---|---|
Provider Name | Ms. Marlene Dissette |
First Address | Lincoln City, OR 97367-5131 |
Second Address | Lincoln City, OR 97367-5131 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/10/2014 |