Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 201900796NP-PP | OR |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 201900796NP | OR |
NPI | 1003315045 |
---|---|
Provider Name | Ryan Tateishi |
First Address | Salem, OR 97309-1129 |
Second Address | Salem, OR 97302-2860 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2018 |
Last Update Date | 11/11/2019 |