| NPI | 1285654194 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KENNETH MILLSAP Owner 541-773-2167 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 200450110) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-08-22 |