Individual
TAKAHLA CIRCLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1401 N 10TH AVE, STAYTON, OR 97383-1311
(541) 852-2746
Mailing address
641 SE ARABIAN, SUBLIMITY, OR 97385-9417
(541) 852-2746
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10043887
OR
Other
Enumeration date
06/24/2025
Last updated
06/24/2025
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