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General NPI Number Information
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NPI Number | 1992951107
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Entity Type | Organization
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Legal Business Name | LWAFP PC INC
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Dates
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Enumeration Date | 08/07/2008
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Last Update Date | 08/07/2008
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Provider Practice Location Address
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Address Line | 181 NW BUNNELL AVE
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City | GRANTS PASS
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State | OR
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Zip | 97526-6012
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Country | US
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Telephone | 541-474-9400
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1925
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City | GRANTS PASS
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State | OR
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Zip | 97528-0163
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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 | CYNTHIA MAHONEY
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Credential | MSN, FNP
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Telephone | 541-474-9400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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