Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201803718NP-PP | OR |
NPI | 1003314766 |
---|---|
Provider Name | Heather Marie Friend |
First Address | Medford, OR 97504-4127 |
Second Address | Medford, OR 97504-6126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2018 |
Last Update Date | 04/01/2022 |