Individual
DEIDRE GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1698 E MCANDREWS RD, STE 300, MEDFORD, OR 97504-5589
(541) 732-7850
(541) 732-7851
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 732-7850
(541) 732-7851
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
82022347
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009238
—
OR
Enumeration date
10/12/2005
Last updated
02/23/2015
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