Organization
VISANA WELLNESS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRACEY STEPHEN KATHER FNP (OWNER)
(541) 251-1010
Entity
Organization
Contact information
Practice address
603 HEMLOCK STREET, 3B, BROOKINGS, OR 97415-9999
(541) 469-9100
(541) 469-9200
Mailing address
PO BOX 6945, BROOKINGS, OR 97415-0353
(541) 469-9100
(541) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
200250089NP
OR
Other
Enumeration date
12/05/2008
Last updated
12/05/2008
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