Organization
WHITE OAK MEDICAL CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DIANE BOLDUC MD (PRESIDENT)
(541) 464-5907
Entity
Organization
Contact information
Practice address
340 NW MEDICAL LOOP, ROSEBURG, OR 97471-1645
(541) 464-5907
(541) 464-8481
Mailing address
340 NW MEDICAL LOOP, ROSEBURG, OR 97471-1645
(541) 464-5907
(541) 464-8481
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QP2300X
Primary Care Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
11/20/2018
Last updated
05/22/2025
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