Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 201350091NP | OR |
NPI | 1003169285 |
---|---|
Provider Name | Kelsey Rose Hupp |
First Address | Silverton, OR 97381-1458 |
Second Address | Silverton, OR 97381-1458 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2012 |
Last Update Date | 25/09/2018 |