# MAE MEDICAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164100756
- **Authorized official:** AMANDA JOHNSON FNP (OWNER/MANAGER)
- **Authorized official phone:** (541) 600-2535

## Contact information

- **Practice address:** 733 N 1ST ST, LAKEVIEW, OR 97630-1507
- **Practice address phone:** (541) 600-2535
- **Mailing address:** 93397 DAIRY CREEK LN, LAKEVIEW, OR 97630-9165
- **Mailing address phone:** (541) 600-2535

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/05/2023
- **Last updated:** 07/05/2023