| NPI | 1093444622 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN BERG Business Manager 503-266-1407 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2022-06-08 |
| Last Update Date | 2022-06-08 |