Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 201500652NP-PP | OR |
NPI | 1013307685 |
---|---|
Provider Name | Christa Elane Degrazia |
First Address | Ashland, OR 97520-1851 |
Second Address | Ashland, OR 97520-1851 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2015 |
Last Update Date | 04/05/2016 |