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Organization
PREMIERE ADULT WELLNESS LLC
Active
Organization
PREMIERE ADULT WELLNESS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMMY STUBER AGNP (OWNER)
(503) 551-9873
Entity
Organization
Contact information
Practice address
3465 DUNCAN AVE NE, SALEM, OR 97301-0811
Mailing address
PO BOX 7897, SALEM, OR 97303-0193
(503) 551-9873
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/07/2025
Last updated
08/07/2025
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