Individual
MIWA OGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
576 OLIVE ST, EUGENE, OR 97401-2642
(541) 344-7303
Mailing address
3283 WILLAMETTE ST, EUGENE, OR 97405-3348
(541) 485-8925
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
037759
—
OR
Enumeration date
01/04/2007
Last updated
07/08/2007
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