Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201506922NP-PP | OR |
NPI | 1003258120 |
---|---|
Provider Name | Tasha Gouin |
First Address | Lake Oswego, OR 97035-3202 |
Second Address | Lake Oswego, OR 97035-3202 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2013 |
Last Update Date | 07/03/2016 |