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General NPI Number Information
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NPI Number | 1497932982
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Entity Type | Organization
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Legal Business Name | KAREN E GRISHAM RN MN PC
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Dates
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Enumeration Date | 01/27/2008
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Last Update Date | 01/27/2008
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Provider Practice Location Address
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Address Line | 1845 COMMERCIAL ST SE
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City | SALEM
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State | OR
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Zip | 97302-5203
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Country | US
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Telephone | 503-363-1422
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Fax |
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Provider Business Mailing Address
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Address Line | 1845 COMMERCIAL ST SE
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City | SALEM
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State | OR
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Zip | 97302-5203
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Country | US
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Telephone | 503-363-1422
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KAREN E GRISHAM
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Credential | RN MN PMHNP
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Telephone | 503-363-1422
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | 000025769N6
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License Number State | OR
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