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Individual

JENNIFER MARIE PROVINCE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
1 UNIVERSITY BLVD, LA GRANDE, OR 97850-2807
(541) 962-3803
Mailing address
2011 4TH ST, LA GRANDE, OR 97850-2511
(541) 962-7808
(541) 962-0860

Taxonomy

Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
202007639NP-PP
OR

Other

Enumeration date
05/05/2020
Last updated
09/02/2020
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