# WHITE OAK MEDICAL CLINIC LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** White Oak Medical Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043003114
- **Authorized official:** DIANE BOLDUC (PRESIDENT)
- **Authorized official phone:** (541) 464-5907

## Contact information

- **Practice address:** 340 NW MEDICAL LOOP, ROSEBURG, OR 97471-1645
- **Practice address phone:** (541) 464-5907
- **Mailing address:** 340 NW MEDICAL LOOP, ROSEBURG, OR 97471-1645
- **Mailing address phone:** (541) 464-5907

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | NULL | — |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 05/22/2025
- **Last updated:** 05/22/2025