Individual
MACI VAN DYKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
996 NW CIRCLE BLVD, CORVALLIS, OR 97330-1485
(541) 768-4370
Mailing address
996 NW CIRCLE BLVD, CORVALLIS, OR 97330-1485
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
CAE-P-10235220
OR
Other
Enumeration date
10/10/2023
Last updated
10/10/2023
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