Healthcare Provider Details

I. General information

NPI: 1700858289
Provider Name (Legal Business Name): MARGOT OUIMETTE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 11/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 W HARVARD AVE STE 310
ROSEBURG OR
97470-2756
US

IV. Provider business mailing address

1813 W HARVARD AVE STE 310
ROSEBURG OR
97470-2756
US

V. Phone/Fax

Practice location:
  • Phone: 541-672-7546
  • Fax: 541-957-8446
Mailing address:
  • Phone: 541-672-7546
  • Fax: 541-957-8446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberLL15893
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: