| NPI | 1588136840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN CORCORAN Owner 503-678-6269 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261QH0100X Clinic/Center Health Service |
| Enumeration Date | 2018-12-27 |
| Last Update Date | 2025-05-13 |