| NPI | 1174717573 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN HENRY WELLER Owner 503-581-6550 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200150116NP) |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2013-07-25 |