Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 20150191NP | OR |
NPI | 1144452335 |
---|---|
Provider Name | Vicky Vy Rodriguez |
First Address | Portland, OR 97208-3158 |
Second Address | Portland, OR 97225-6603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2009 |
Last Update Date | 04/12/2015 |