Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 202008543-NP | OR |
NPI | 1427665017 |
---|---|
Provider Name | Katlin Mostue-Nesbit |
First Address | Medford, OR 97504 |
Second Address | Medford, OR 97504-7337 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2020 |
Last Update Date | 12/01/2021 |