Individual
HEATHER LARENA BASCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
2825 E BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-7000
Mailing address
2825 E BARNETT RD, MEDFORD, OR 97504-8332
(541) 789-7000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
362422-3102
UT
363LF0000X
Family Nurse Practitioner
Primary
10021529
OR
363LF0000X
Family Nurse Practitioner
362422-4405
UT
Other
Enumeration date
10/10/2019
Last updated
07/18/2024
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