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General NPI Number Information
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NPI Number | 1366790404
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Entity Type | Organization
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Legal Business Name | HEALTHY U MEDICAL CLINIC LLC
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Dates
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Enumeration Date | 08/21/2012
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 7208 HIGHWAY 238
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9131
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Country | US
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Telephone | 541-414-3130
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 OLD STAGE RD
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City | CENTRAL POINT
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State | OR
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Zip | 97502-9796
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Country | US
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Telephone | 541-414-3130
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. NATALIA NAZARTCHOUK
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Credential | NP
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Telephone | 541-414-3130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 201150045NP
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License Number State | OR
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