Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant | LC-LC-10190129 | OR |
NPI | 1124593454 |
---|---|
Provider Name | Sarah E Fuller |
First Address | Portland, OR 97216-1939 |
Second Address | Portland, OR 97216-1939 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/10/2018 |
Last Update Date | 13/10/2018 |