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General NPI Number Information
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NPI Number | 1780048124
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Entity Type | Organization
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Legal Business Name | DEGRAZIA WELLNESS, LLC
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 05/18/2016
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Provider Practice Location Address
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Address Line | 3210 HILLCREST PARK DR SUITE 100
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City | MEDFORD
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State | OR
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Zip | 97504-7693
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Country | US
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Telephone | 541-494-8888
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Fax | 541-494-1300
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Provider Business Mailing Address
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Address Line | 3210 HILLCREST PARK DR SUITE 100
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City | MEDFORD
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State | OR
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Zip | 97504-7693
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Country | US
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Telephone | 541-494-8888
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Fax | 541-494-1300
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MRS. KARISSA STULTS
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Credential |
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Telephone | 541-890-5217
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 201500652NP-PP
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License Number State | OR
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