| NPI | 1578760740 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MAXINE PROSKUROWSKI Program Manager 541-790-7215 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: OR 201050226NP) |
| Additional Taxonomies | 103TC1900X Psychologist, Counseling (Licence: OR 5043) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2015-01-21 |