Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 33003N1 | OR |
N | 363LW0102X | Nurse Practitioner - Women's Health | 33003N7 | OR |
NPI | 1023098068 |
---|---|
Provider Name | Patricia Lee Brandon |
First Address | Portland, OR 97209-2646 |
Second Address | Portland, OR 97209-2646 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2006 |
Last Update Date | 27/02/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R142614 | (02) | OR |