| NPI | 1639468432 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL L JOHNSON Office Manager 541-450-8345 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner Adult Health (Licence: OR 200850056NP) |
| Enumeration Date | 2011-04-01 |
| Last Update Date | 2011-04-01 |