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General NPI Number Information
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NPI Number | 1184784332
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Entity Type | Organization
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Legal Business Name | PAULINA PEAK FAMILY HEALTHCARE INC
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 10/24/2012
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Provider Practice Location Address
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Address Line | 51384 HIGHWAY 97
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City | LA PINE
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State | OR
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Zip | 97739-9871
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Country | US
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Telephone | 541-536-8060
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3389
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City | LA PINE
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State | OR
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Zip | 97739-3389
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Country | US
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Telephone | 541-536-8060
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | GREGORY L MILLER
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Credential |
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Telephone | 541-536-8060
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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 | 200250124NP
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License Number State | OR
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