| NPI | 1710763123 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMY DAWN MOORE Regional Contracting Director 971-430-2335 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2023-09-01 |
| Last Update Date | 2024-06-14 |