| NPI | 1225593197 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATIE S NICOSIA Owner 503-406-1009 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0405X Clinic/Center, Rehabilitation, Substance Use Disorder |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2019-02-05 |
| Last Update Date | 2020-03-06 |