Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201706355NP-PP | OR |
NPI | 1003322330 |
---|---|
Provider Name | Brady William Sweat |
First Address | Klamath Falls, OR 97601-1106 |
Second Address | Klamath Falls, OR 97601-1106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2017 |
Last Update Date | 22/12/2017 |