| NPI | 1063754208 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRENDA L STARK Office Manager 541-889-2244 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 079043254N1) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200550081NP) |
| 363LP2300X Nurse Practitioner, Primary Care | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2022-10-19 |