Individual
DIANA JAYE WAMBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
1270 KOT-NUM RD, WARM SPRINGS, OR 97761-1209
(208) 336-1836
Mailing address
PO BOX 1209, WARM SPRINGS, OR 97761-1209
(208) 336-1836
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NP 370A
ID
Other
Enumeration date
08/26/2008
Last updated
12/28/2012
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