# LWAFP PC INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Living Water Adult Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1992951107
- **Authorized official:** CYNTHIA MAHONEY MSN, FNP (PRESIDENT)
- **Authorized official phone:** (541) 474-9400

## Contact information

- **Practice address:** 181 NW BUNNELL AVE, GRANTS PASS, OR 97526-6012
- **Practice address phone:** (541) 474-9400
- **Mailing address:** PO BOX 1925, GRANTS PASS, OR 97528-0163

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LA2200X | Adult Health Nurse Practitioner | — | NULL | Yes |
| 363LA2200X | Adult Health Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/07/2008
- **Last updated:** 08/07/2008