| NPI | 1639458011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ANN NAMETKA Owner 971-895-0060 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Additional Taxonomies | 261QM2500X Clinic/Center, Medical Specialty |
| Enumeration Date | 2011-08-16 |
| Last Update Date | 2024-01-28 |