| NPI | 1710797378 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANNING DANAE FLURY Manager 971-570-0299 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2025-03-12 |