| NPI | 1790113405 |
|---|---|
| Doing Business As | PROVIDENCE HEALTH EXPRESS BP |
| Entity Type | Organization |
| Authorized Contact | KEENAN B FREEMAN CFO 503-893-6524 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 261Q00000X |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2013-10-16 |