Individual
MISS CARLIE D IRVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
500 SW RAMSEY AVE, GRANTS PASS, OR 97527-5554
(541) 472-7000
(541) 776-2892
Mailing address
PO BOX 4749, MEDFORD, OR 97501-0227
(541) 789-5516
(541) 789-5518
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200850141NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
227698
—
OR
Enumeration date
10/28/2008
Last updated
12/27/2012
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