Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 000033561N6 | OR |
NPI | 1033285713 |
---|---|
Provider Name | Mrs. Rita Herlong |
First Address | Salem, OR 97304-0785 |
Second Address | Salem, OR 97302-1764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2006 |
Last Update Date | 20/05/2016 |