| NPI | 1124499124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KARISSA STULTS VP Of Billing And Contracting 541-930-8545 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: OR 086006299N7) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2026-07-31 |