Individual
BIANCA DERIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1015 PRESTWICK CT, FLORENCE, OR 97439-9585
(541) 574-9570
(541) 574-8857
Mailing address
1015 PRESTWICK CT, FLORENCE, OR 97439-9585
(541) 574-9570
(541) 574-8857
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
04-03-13
OR
Other
Enumeration date
02/10/2016
Last updated
02/10/2016
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