Facts
- Status
- A
- Credential
- A.R.N.P.
- Type
- Individual
- Enumeration date
- 2005-05-31
- Last updated
- 2014-01-21
Specialties
Licenses
- License WA
- AP30006914
Location
- Practice location
- 25647 REDWOOD HWY
- City
- CAVE JUNCTION OR
- Postal code
- 975239332
- Phone
- 541-592-4111
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.