Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 202103289NP | OR |
NPI | 1033884275 |
---|---|
Provider Name | Mona Kaahu |
First Address | Grants Pass, OR 97526-1051 |
Second Address | Grants Pass, OR 97526-1051 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/08/2021 |
Last Update Date | 10/08/2021 |