Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 174N00000X | Lactation Consultant |
NPI | 1245637164 |
---|---|
Provider Name | Sarah Longwell |
First Address | Portland, OR 97214-3235 |
Second Address | Portland, OR 97214-3235 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2014 |
Last Update Date | 20/11/2014 |