Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 200550028NP | OR |
NPI | 1043247059 |
---|---|
Provider Name | Virginia Lee Harris |
First Address | Portland, OR 97239-6102 |
Second Address | Portland, OR 97239-6102 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 22/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
067593032 | BLUE CROSS/SHIELD PIN (01) | OR |
Q41921 | (02) | OR |