Individual
NOLAN BASTENDORFF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
537 UNION AVE FL 2, GRANTS PASS, OR 97527-5543
(541) 507-2110
Mailing address
537 UNION AVE FL 2, GRANTS PASS, OR 97527-5543
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
OR
Other
Enumeration date
07/17/2023
Last updated
12/29/2023
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