| NPI | 1053153452 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIE SHINE Director Of Finance 541-389-6313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 207K00000X Allergy & Immunology |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2024-06-07 |
| Last Update Date | 2024-06-07 |