Individual
SUSAN BASILICATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1200 MIRA MAR AVE, MEDFORD, OR 97504-8546
(541) 664-5151
Mailing address
1208 BEALL LN, CENTRAL POINT, OR 97502-1573
(541) 664-5151
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
07804146RN
OR
Other
Enumeration date
01/31/2006
Last updated
11/26/2007
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