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Individual

MS. THERESA JAINN BIDWELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
FNP/PA-C

Contact information

Practice address
8495 CRATER LAKE HWY, 118-GV, WHITE CITY, OR 97503-3011
(541) 826-2111
Mailing address
PO BOX 943, GOLD HILL, OR 97525-0943
(541) 821-1919

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA00451
OR
363LF0000X
Family Nurse Practitioner
392031
CA

Other

Enumeration date
06/06/2006
Last updated
01/23/2017
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