| NPI | 1275793796 |
|---|---|
| Former Legal Business Name | WILD ROSE CLINIC |
| Entity Type | Organization |
| Authorized Contact | JEAN A KIMERLING Operations Manager 509-551-9981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP30003677) |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2008-06-10 |