| NPI | 1093140188 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE BENNETT Owner 503-729-1380 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 15738542) |
| Enumeration Date | 2013-09-07 |
| Last Update Date | 2024-03-28 |