Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | MD22479 | OR |
Y | 207RP1001X | Pulmonary Disease | MD22479 | OR |
NPI | 1083711857 |
---|---|
Provider Name | Vandy Lee Sherbin |
First Address | Portland, OR 97210 |
Second Address | Portland, OR 97210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 03/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
288288 | (05) | OR |
F58143 | (02) |