Individual
AUDRIE KINGZETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPM, LDEM
Contact information
Practice address
400 CRATER LAKE AVE, MEDFORD, OR 97504-6808
(541) 772-2291
(541) 245-0417
Mailing address
3000 DELTA WATERS RD, MEDFORD, OR 97504-5840
(541) 261-3950
(541) 245-0417
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
DEM-LD10166074
OR
Other
Enumeration date
01/13/2015
Last updated
01/13/2015
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