| NPI | 1205305190 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE BOLDUC President 541-464-5907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2018-11-20 |
| Last Update Date | 2025-05-22 |