| NPI | 1003560517 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ELIZABETH PONDOLFINO Medical Office Manager 971-328-0083 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health |
| Enumeration Date | 2022-02-04 |
| Last Update Date | 2022-02-04 |