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Organization
LWAFP PC INC
Active
Organization
LWAFP PC INC
Active
Other names
Living Water Adult Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
CYNTHIA MAHONEY MSN, FNP (PRESIDENT)
(541) 474-9400
Entity
Organization
Contact information
Practice address
181 NW BUNNELL AVE, GRANTS PASS, OR 97526-6012
(541) 474-9400
Mailing address
PO BOX 1925, GRANTS PASS, OR 97528-0163
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
NULL
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/07/2008
Last updated
08/07/2008
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