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General NPI Number Information
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NPI Number | 1376076414
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Entity Type | Organization
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Legal Business Name | HIGH DESERT WOMEN'S CARE
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Dates
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Enumeration Date | 04/05/2017
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Last Update Date | 04/05/2017
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Provider Practice Location Address
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Address Line | 1245 NW 4TH ST STE 201
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City | REDMOND
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State | OR
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Zip | 97756-1680
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Country | US
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Telephone | 541-323-6274
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Fax |
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Provider Business Mailing Address
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Address Line | 1245 NW 4TH ST STE 201
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City | REDMOND
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State | OR
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Zip | 97756-1680
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LORI MCRAE
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Credential | WHNP
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Telephone | 541-323-6274
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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 | 201601498NP-PP
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License Number State | OR
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