| NPI | 1447752035 |
|---|---|
| Doing Business As | CRATER LAKE MEDICAL SOUTH |
| Entity Type | Organization |
| Authorized Contact | LAURA LYNN JOHNSON Nurse Practitioner 541-890-8826 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201050002NP) |
| Enumeration Date | 2018-02-28 |
| Last Update Date | 2024-06-25 |