| NPI | 1093053431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MONICA FERGUSON Owner 503-358-7908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: OR 200650008NP) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: OR 200650008NP) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2015-05-23 |