Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | LD-10190418 | OR |
NPI | 1023514601 |
---|---|
Provider Name | Sarah Jean Mcclure |
First Address | Portland, OR 97206-4059 |
Second Address | Portland, OR 97211-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2018 |
Last Update Date | 03/04/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
LD-10190418 | OREGON STATE LICENSURE (01) | OR |