Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | R168345-5 | MN |
Y | 363LN0000X | Nurse Practitioner - Neonatal | 104039 | AK |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | R 168345-5 | MN |
NPI | 1336430305 |
---|---|
Provider Name | Tara Eileen Haman |
First Address | Portland, OR 97208-4105 |
Second Address | Anchorage, AK 99508-4615 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2011 |
Last Update Date | 29/10/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ENROLLED | (05) | IA |
ENROLLED | (05) | MN |