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General NPI Number Information
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NPI Number | 1013030444
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Entity Type | Organization
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Legal Business Name | THE FAMILY HEALTH CLINIC OF LAPINE
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Dates
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Enumeration Date | 04/09/2007
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Last Update Date | 10/18/2007
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Provider Practice Location Address
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Address Line | 16480 WILLIAM FOSS RD
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City | LA PINE
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State | OR
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Zip | 97739-9486
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Country | US
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Telephone | 541-536-8012
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Fax | 541-536-9873
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Provider Business Mailing Address
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Address Line | PO BOX 126
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City | LA PINE
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State | OR
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Zip | 97739-0126
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Country | US
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Telephone | 541-536-8012
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Fax | 541-536-9873
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRENDA J MOLINA
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Credential |
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Telephone | 541-536-8012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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