| NPI | 1649155201 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KA'IMIALAIMAKA LA VINE Owner 971-238-4543 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-08-11 |
| Last Update Date | 2025-08-19 |