Individual
KEMBLE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
10365 SE SUNNYSIDE RD STE 340, CLACKAMAS, OR 97015-5751
(541) 579-2800
Mailing address
1077 GATEWAY LOOP, SPRINGFIELD, OR 97477-1114
(423) 335-0929
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201600267RN
OR
363LG0600X
Gerontology Nurse Practitioner
Primary
201600268NP-PP
OR
Other
Enumeration date
01/13/2016
Last updated
05/13/2021
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