Organization
SHE SOARS PSYCHIATRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUMMER WHITTAKER (CREDENTIALING SPECIALIST)
(617) 453-9505
Entity
Organization
Contact information
Practice address
102 E MAIN AVE # 300A, SISTERS, OR 97759-0180
(541) 595-8337
(503) 200-1433
Mailing address
PO BOX 2206, SISTERS, OR 97759-2206
(541) 595-8337
(541) 200-1433
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201402707RN
OR
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
201403159NP-PP
OR
Other
Enumeration date
03/22/2018
Last updated
03/22/2018
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