Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 082011212N3 | OR |
NPI | 1003909961 |
---|---|
Provider Name | Terri J Warren |
First Address | Portland, OR 97210-3442 |
Second Address | Portland, OR 97210-3442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MW0135409 | DEA (01) | OR |
P15835 | (02) | OR |