| NPI | 1033718242 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN M HAGEN Owner, President 541-313-8501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2020-10-19 |