Individual
ULISTA JEAN BROOKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2600 CENTER ST NE, CLINIC OREGON STATE HOSPITAL, SALEM, OR 97301
(503) 945-2800
Mailing address
PO BOX 14900, SALEM, OR 97309-5016
(503) 945-9840
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD10888
OR
Other
Enumeration date
09/25/2006
Last updated
07/08/2007
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