| NPI | 1922706803 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLY WITBECK Owner 503-799-8679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2023-02-20 |
| Last Update Date | 2024-02-18 |