Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 201902328NP-PP | OR |
Y | 363LG0600X | Nurse Practitioner - Gerontology | 201902328NP-PP | OR |
N | 363LP2300X | Nurse Practitioner - Primary Care | 201902328NP-PP | OR |
NPI | 1023576659 |
---|---|
Provider Name | Rhezarie Mae A Agtarap |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97213-2933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/03/2019 |
Last Update Date | 04/02/2022 |